Laserfiche WebLink
FCJR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> -------- ...... .......... --------- Permit No. ........ ...... <br /> (Complete in Triplicate) <br /> ................. --------------­- ........ Date Issued <br /> ....... ...... ........ This Permit Expires I Your From Date Issued <br /> Application is hereby made to-the Son Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application *46ocle in compliance with County Ordinance No, 549 and existing Rules and Regulations., <br /> . ....... .........:...........•.:.: <br /> f­f.. ... CENSUS TRACT........ .. . <br /> JOB ADDRESS/LOCAT)O <br /> Owner's Name ..... .. .. .. .. . . . . ........... <br /> ...... ..........Phone ............................... <br /> . city �:.V, <br /> Address ......... . . ................................... <br /> t Contractor's Name <br /> .....License # Phone ............................... X/ <br /> ....... .......... <br /> Installation will serve. Residence Apartment House C] Commercial :oTraller Court 0 <br /> Motel C]Other --------_----------;jiL­1......... <br /> Number of living units:...... ---- Number of bedrooms _--....Garbage Grinder ------------ Lot Size ............. ....... <br /> Water Supply; Public System and name ................................. ........................................ .......... ......................PrivateA <br /> Character of soil to a depth of 3 feet. Sand 0 Silt❑ Clay C] - Peat[3 Sandy-Loam 0_Cloy Loom 0 <br /> Hardpan E] Adobe Fill M6terial ............ If yes, type ----------_---_---------- <br /> (Plot PI an, -showing size!of lot, location of system. in relciti66"to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pi4'permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK f j. Size............ ................... ............ Liquid Depth .......................... <br /> Capacity ---------- ...... Type .................. Material...................... No. Compartments .................. <br /> Distance to nearest: Well ...........__.....................Foundation ...................... Prop. Line....................... <br /> LEACHING LINE No. of Lines ........................ Length of each line.--------___..__._...._..... Total Length ............................ 00 <br /> -Filter' Material- --------- .................................. <br /> V Box .... ........Type Filter Material ... <br /> Disti6nce to nearest- Well ........................ Foundation .f..._...__.._._........ Property Line ...... ................ <br /> SEEPAGE PIT Depth ................ --- Diameter ................ Number ........... ................ Rock Filled Yes 0 No 0 <br /> Water Table Depth ................ .................Rock Size .................... ........... <br /> Distance to nearest.. Well ---------- ....................Foundation ............ ....... Prop. Line................ ........ <br /> REPAIR/ADDITION(Prev. Sanitation Permit 0 ..... ..........__....................... Date .................................. <br /> Septic Tank (Specify Requirements) -----------_--------- --------------­--­-- ........... ............................................. .......................... <br /> D*"Pol Hey (Specify Requirements) .............. .........._------- <br /> - - --------- <br /> - -- -------- ------------------­----------- ....................... <br /> ..... ....... ..... ---------- <br /> ------------ <br /> raw el;;��t_i_n_c6ja required addition on reverse side) With Son Joaquin <br /> I hereby certify that I have prepared this. application and that the work will be done In accordance <br /> County,Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Mom* owner or licen- <br /> sed agents signature certifies the following- <br /> "[ certify that in the performance of the worn far which this permit is Issued, I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ... ............... _-------- ....... Owner <br /> .............. ................. <br /> ...... Title ............... <br /> BY ....... -------------- <br /> pi`oi�er than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY __7.��.......... .?�7. .7. .. . ............. ................... DATE ....q. ........... <br /> BUILDINGPERMIT ISSUED I .....................:..............7/........I....................... ..............DATE ------------------------------------------- <br /> _7 <br /> ADDITIONAL COMMENTS ........I................................................ ............... --._.._....---------...._.......•-----......_.....---...-----•. .................... <br /> ----------- ....................................... .................... <br /> .......... .......... ................................................ ....................... <br /> ........... ............ ........ ..............._ . <br /> ----------------­ ............................... ..................... -----------•---•-••-•.......................... ... ...........2-- <br /> . ...... .... <br /> Final Inspection by. ................. ........ ............ <br /> i ----•-.............Date ....... .... ......... <br /> LO L AL <br /> SAN JOAQUIN ALTH DISTRICT <br /> 7/72 3 X <br /> r w 13 24 1_-Asi o.,, ;AA <br />