Laserfiche WebLink
"FOR OFFICE USE. <br /> APPLICATI1 'SANITATION PERMIT <br /> ....... ...... ............. ........ Permit No. ............ <br /> (Complete In Triplicate) <br /> ..........1—.......................... ............... . <br /> Date ........ <br /> .................... ..................I................. This Permit Expires I Year from Dote Issued <br /> Application Is <br /> hkeby,-nad6 to the Son Joaquin Local Heafth District for a permit to construct and install the work herein <br /> described.-This bppl6tiari is made In compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> V <br /> JOB ADDRESSAOCATZ0 .1 .. a.... 14�-X.,._............CENSUS TRACT .......................... <br /> : ,r4 _­­ <br /> 7- . .......................;..........................I................Phone ...... ............­.......... <br /> Owner's Name ..... <br /> Address ............... ....:..............•-•----------•--................. city ............... ........................ ............ ........... <br /> Contractor's Name ..............' .....:_........................----_._._.............License # .................... Phone ........................ <br /> Installation will serve: Residence[I Apartment House 0 Commercial OTraller Court 0 <br /> Motel o Other............................................ <br /> Number of living units:__....:_.._ Number of bedrooms J�....Garbqge Grinder ...... Lot Size .......................... ........... <br /> Water Supply: Public System and name ......_.---•.................................. ...........-1—......................... .......—.............Private 0 <br /> Character of soil to a depth of 3 feet: Sand 0 Silt 0 Clay 0 Peat 0 Sandy Loom 0 k Clay Loom or <br /> Hardpan[) Adobe 0 Fill Material ............If yet,type ...............L............ <br /> - ,, <br /> (Plot plan, sh wing size of 'lot, location of system In relation to wells, buildings, etc. must be placed -on reverse side.) . <br /> P a it permitted if public sewer is available within 200 feet,) <br /> NEW INSTALLATION: (No septic tank or seepa <br /> p <br /> Size.... ................___..................... Liquid Depth ........ <br /> PACKAGE TREATMENT j SEPTIC TA 17 <br /> ev <br /> y C4,01e_ No. Compartments .....-..--•....... P; <br /> Copacito------ T pePOAAA-v/....... Material 4p,., <br /> Distance,to nearest: Well ....................Foundation .../V. ..... Prop. Line ......4 ........... <br /> LEACHING LINE [9-'_`No. of Lines .......I.............. Length of each line ?-'Total Length .... <br /> V Box 4!0------ Type filter Material ...�_....Depth Filter Material ....... ......................... <br /> pe If- .......... <br /> Distance to nearest.. Well 43��'*Y Foundation ............ Property rty (Ina ....I.......... <br /> . ....... . <br /> SEEPAGE PIT Depth ----- Diameter 49=172, Number ............./............. Rock 'Filled Yes- j- o 0 <br /> Water Table Depth ...... .................ly... ..................Rock Size ................................. <br /> Distance to nearest: Well .......__.,..........................Foundation . Prop. Line ............. <br /> REPAIR/ADDITION lPrev. Sanitation Permit# ---•--•----------•-----------**............. Date ..........._........------......--1 <br /> Septic Tank {Specify Requirements) --_-_---------- ....................... .......................... ........................I..........4—---------­-- <br /> Disposal Field (Specify Requirements) ---•------------------------•--------• -_--• ---------_-------------- ................. --------- ................ <br /> -------------------------------•-•---..__......... ----------- ------------------ ....... .............i--------•----------•----•------ ................. ................... <br /> ----------------------------...... -----------.........---••-•--------- ------••-----_..----- ..........................m.................... -----------­- ................ <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with Son Joaquin' <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health,01str(ct. Horne owner or licen- <br /> sed agents signature certifies the following: <br /> N certify that in the rformance of <br /> e we for Which this permit Is Issued, I shall not.at employ any <br /> y person In such manner <br /> as to become sub[ Workman' 0 ation laws of California." <br /> n 10 4 <br /> Signed - -- -------------- --- -------- ......................... ---------- Owner <br /> By ---------------- --------------- ------ -------------- --------- ------------------------- .......... <br /> --- -----I------------ -------_----------- Title llf other than owner) <br /> DEPARTMENT USE ONLY <br /> of//� ...(]ATE... ............ .............­-D 7------ <br /> APPLICATION ACCEPTED BY ....... . ... .....I....... ------------ ---------------- <br /> BUILDINGPERMIT ISSUED ------- --------------------------------------------------------------------------------- ................DATE .. .................................. <br /> ADDITIONALCOMMENTS ----------------------------------------------------------------------**......­* -----------*------- .....................w........­I--------- <br /> -----------------------*-------------------------------------------- ..................................... ..................................... ...................................................I....... <br /> --------------------------------------------- ------- . . ................... ------—................................ ............ ................................. <br /> ................. ....... -------------------------------------- ........ ................ ........... <br /> Fi---------------------------------- ---------­ —.9-7......._...... <br /> nal Inspection by: __*�.......­­­-Z ....... ..........I.............................................Date <br /> EH 13 .2b 1-68 Rev. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT 8/711 3M <br />