Laserfiche WebLink
FOR OFFICE USE, <br /> APPLICATION FOR SANITATION PERM <br /> ......................... .... Permit N6.7 <br /> ..................... <br /> (Complete In Triplicate) <br /> .......... ...... <br /> Date Issued/ r <br /> 0........... This Permit Expires I Year from Date-issued <br /> ..................... . <br /> .......... 7-7-1 <br /> Application is hereby made to the Son Jo;q6hi Local Health District fora- .permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance,No. 549 and existing Rules and Regulations.- <br /> JOB ADDRESS/LOCATION._... ....... . .. ...... ............... ........................I...........CENSIJI� TRACT .......................... <br /> Owner's Name ............................._...................................Phone ., ..... <br /> Address ................... ...... City ... <br /> ............. .............. ................... <br /> 07 <br /> Contractor's Name ----------_r?r� .... .. .......... ----. ..._..._.......---...License Phone .......... <br /> Installation will serve: `Residence)?(Apartment House C) Commercial OTraller Court 0 <br /> :Motel ❑Other ------- .......­.......................... <br /> Number of living Number of bedrooms ---A....Garbage Grinder ....... Lot Size ...... .. . ......... <br /> 7 1.... .... .... .. <br /> ..............I <br /> .Cj <br /> Water Supply: Public System and name ........_...............................­........... ....... .......Private 0 <br /> Character of soil to a depth of 3 fee. Sand t] Silt 0 Clay 0 Peat 0 Sandy Loom 0 Clay Loom 0 <br /> Hardpan 0 Adobe 0 Fill M6terial ............ If yes,type........ ...... .... ....... <br /> (Plot plan, showing size of 'lot,' location of system In relation to wells, buildings, etc. 'must be placed on 'reverse side.) <br /> NEW INSTALLATION. (No septic>tank-or seepage pit permitted If public sewer Is available within 21DO feet,] <br /> t. PACKAGE TREATMENT -SEPTIC TANK f Size....................:.......•---•--•---....----- Liquid Depth .................... <br /> capacity - ------ ... Type------ ....... Material....................._ No. Compartments .......................ly <br /> Distance to.-nearest: Well .............:......................Foundation ......................"Prop, Line ......................V <br /> LEACHING LINE No. of Lines'......­-----­-------- Length of,each line............................ Total Length ............... ............. <br /> V Box _7----7.... Type Filter Material ...................Depth Filter Material ........:.......................... ....... <br /> Distance to nearest: Well•.....................--Foundation ........................ Property Line .................... <br /> SEEPAGE PIT Depth ------------_-- Diameter -----------I..... Number ---•........................ Rock Filled Yes ❑ No <br /> i Cl <br /> Water Table Depth ............................... ..................Rock Size ................................ <br /> Distance to nearest: Well .-.................. ..................Foundation .................... Prop. Line-................. <br /> REPAIR/ADDITION(Prev. Sanitation Per ............ ....... Date -------------------- ...... <br /> �nts) ----------- <br /> Septic Tank (Specify Requirements) . ...... . .................. <br /> V- <br /> Disposal Field (Specify Requirements} ...... ---------•-•-••-••--•--- ....... <br /> A) A------------------------------------------------------ ---------­----­------ --------- <br /> ............... .... .................. ............... ........ <br /> -------­----------I-------------------------------------------------------------------------------- -------- ........... ...... ............................;------ ................... <br /> (Draw existing and required addition on reverse sidel <br /> I hereby certify that I have prepjared this application and that the. work will be done In accordance with Son-Joaquin <br /> County Ordinances, State L aws,-and-Ruies-and.Regulations of-the Son Joaquin Local Heal&Dlstrici. Home owner or licew <br /> sed agents signature certifies the following: 1 . <br /> "I certify that in the performance of the work for which this permit is issued, I *hall not employ any person In such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ...___----- -------- Owner <br /> BY ---------- --- ---------- . ... <br /> ----------------- ...... <br /> -------------Title <br /> -------- -------------­--- ---------------------- ........... <br /> (if other a owner) <br /> FOR DEPARTMENT USE ONLY <br /> f <br /> APPLICATION ACCEPTED BY __C.,., ---------------------------......-•--•-- ..------11----------------------------_ DATE-C�7. .....f.. . . ................... <br /> BUILDING PERMIT ISSUED 4.--- ------------ ----- ---------------------- <br /> .......DATE ........................... <br /> ADDITIONAL COMM TS <br /> "..... 7 A-0--v _,00" Afte..... ..... <br /> ....................I....................... ............4 -----------•- <br /> -------- ------------ --------- ----------------------------------- .................... .................­------- <br /> ......................... <br /> --------------------------------------------------------------- -------- ......... <br /> Date Final Inspection by. ..................................... ............................D .......... <br /> ....APP ,��44��_ 7 <br /> EH 13 24 1:-68 a6v. 5m - I <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M <br />