Laserfiche WebLink
FOR OFFICE USE.- <br /> APPLICATION FOR SANITATION PERMIT <br /> .................................4..... Permit NO 62:.,i.. <br /> lComplefe In Triplicate) <br /> ...... ........ .. <br /> Date Issued <br /> .... . ......... This Permit Expires 1 Year From Date Issued <br /> .................­­........... . . <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 is mad--In compliance with Count x Ordinance No. 549 and existing Rules and Regulotions-, <br /> JOB ADDRESS/LOCA . .. .... ............. ..........CENSUS TRACT ....... .................. <br /> - - -- ---------------- ....... ....... . ..... <br /> Owner's Name ....... __13R.,cb L �� ---------Phone .......---• _............ <br /> 0 r .1>- -. <br /> ........ .......... Cit ...... ........ ........................ <br /> Address ............. -------- <br /> Contractor's Name --- ------ --- l ..........................License 4c=A94r_.�. .. Phone� <br /> Installation will serve. Residence partment House 0 Commercial OTraller Court 0 <br /> Motel C]Other ............................... <br /> Number of living units:-------if" Number of dro ms ,....._Garbage Grinder Lot Size .. ... ........ ...... ........ ......... <br /> Water Supply: Public System and n'orn .........—.............................Private 0 <br /> !4 <br /> Character of soil to o depth of 3 feet.- Sand E] Silt 0 Clay 13, t El Sandy Loom 0 Clay Loom 0 <br /> Hardpan Q Adobe Eg-44TMaterial ............If yes,type.....6....... . ........... <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 200 feet)-' <br /> PACKAGE TREATMENT SEPT CTANK I Size........__----------- ......................... Liquid Depth .................. <br /> I %L <br /> Capacity -------------------- Type ... .......... Material...................... No. Compartments ...................... <br /> Distance'to nearest. Well ....................................Foundation ...................... Prop. Line ...................... <br /> LEACHING LINE No. I of-Lines ------------------------ Length of each line-.-.-- ----_----------_- Total Length ......... ............... <br /> V Box _­------- Type Filter Material ....................Depth Filter Material .............. ................... .......... <br /> Distance to nearest: Well --------------_------- Foundation ------------------------ Property Line ................... <br /> SEEPAGE PIT Depth ------I i <br /> ------------- Diameter __.............. Number ............. .............. Rock Filled Yes 0 N0,01 <br /> .°­Wdter-'TdbI6.,.D6pth ............ ........_......—..........Rock Size ................................ <br /> Distance to nearest: Well ......... ............ .Foundation -------------------- Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ...... ... ... <br /> I I _.e", /b N I <br /> Septic Tank (Specify Requirements) --­---------- .......... <br /> Disposal Field (Specify Requirements) ...... ...... ..- <br /> iv <br /> ............ <br /> ------­------- --------------------••. ------ .............. ........................................................................... ------- ................ <br /> ii <br /> .----------•----------------------------------------------------------------------------------------............................................................................ ............... <br /> (Draw existing and required addition on reverse side) <br /> 1 hereby certify that I have prepared this application and that the work will be done in accordance with Son Joaquin <br /> County Ordinancesi, State Laws, and Rules-and Regulations of the Son Joaquin Local Health,District. Rome owner or 11cen- <br /> sed agents signotu'r;certifies the falEowing: <br /> "I certify that in the performance of the work for which this permit is issued;I shall. not-employ-any-person In such manner <br /> as to become subject I WorkMan"i'Compensation laws of California." <br /> subject <br /> Signed ------------- . .... ....... ...... .. ............................... Owner <br /> By ............................. ------- <br /> 0 -- ----------------------------------------- <br /> (Ifo an eowner) <br /> Of FOR DEPARTMENT USE ONLY <br /> APPLICAT104'ACCEPTED BY ----.- �_ _' _�__------------- ---------_............... DATE 3 7-b............... <br /> ---- ------------ -------•- --- <br /> BUILDING PERMIT ISSUED -------------a------•-•--•-----•------....._...-.........................................................DATE ............................... <br /> ADDITIONALCOMMENTS .............:.!_.......__...........*......­_­----------------*........*....... ------ .............. ..................................... ... <br /> ------------------------ ----------------------------1�- <br /> ri-------7-------------------------------------------------- ------- ------------------- ------------------------------------------------- ........ <br /> ------------------------------------------------ -------- -------------------- ------------ ------------------------------------- ------------------------------------------------------------------ <br /> ------------------- ------- ---------- <br /> Final ln!�p�ctioWby: ....... ------- - -------------------------------*------------------------ ---- ---------6o--t---- <br /> ----------------------*-*"'**........**------------------------------------ _-----_------_ ......... <br /> EH 13-24 1-68 ikv. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M <br />