Laserfiche WebLink
FOR OFFICE USE. <br /> APPLICATION FOR SANITATION PERMIT <br /> ._1.Z.N7 <br /> ...... Pe <br /> .......... <br /> lComplete in Triplicate) rmit No, <br /> .............. <br /> ......... F..._..._............_._..... This Permit Expire's I-Year From Date Issued Date Issued .......... <br /> Application is hereby made to the San'Joaquin Loco 1�146dfihlbistrict for a permit to construct and install the work herein <br /> described. This application is made in compliance with Co6i4y'Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION .. ....... ........CENSUS TRACT .............. <br /> Owner's Name ................................................. ...... ...Phone -•----.--.--..------- ................ <br /> Address494/1................................. City V7 .........._...................................... <br /> Contractor's Name <br /> ....710�0/_rzx............... ---­- License --- Phone <br /> ----- --------------- <br /> Installation will serve- Residence Apartment House,E] Commercial E]Trailer Court C] <br /> Motel n Other . .... . . ............................... <br /> Number of living units:... ..... Number of bedrooms ..../-----Garbage Grinder Ifl.e.... Lot Size tof ................... <br /> Water Supply: Public System and name �7' ----------------- _----------Private 0 <br /> Choracter of soil to a depth of 3 feet: Sand 0 Silt 0 Cloy M Peat F] Sandy Loom E] Clay Loam ❑ <br /> Hardpan E]q Adobe g Fill Material 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� O permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK fA Siz ------ Liquid Depth..........I....... <br /> Capacity h9e. ...... Type No. Compartments -1-—----------------- <br /> Distance to nearest: Well <br /> ........... -------Foundation Prop. Line/ ---------- ....... <br /> LEACHING LINE No. of Lines .... Length of each line .............. Total Length llr*7A�5 .. ....... <br /> 'D' Box/.f/e7_ Type Filter Materioll!Wpq��_ _-.Depth Filter Material <br /> .......................__................ <br /> Distance to nearest. Well ------- Foundation ..1e.1........... Property Line ------------ <br /> `SEEPAGE PIT Depth 00 Diametert-2-0........... Rock Filled Yes, ]' No (:1 <br /> e, <br /> Water Table Depth --- <br /> -- -------- :......................Rock Size <br /> X-_----....... .. <br /> Distance to nearest; Well _________________Foundation ----- Prop. Line . ................ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Dote ------------_---_ -_•-----.._--1 <br /> Septic Tank ISpecify Requirements) .................... ---------------------- .................................. ....... ---------- ......... <br /> Disposal Field (Specify Requirements) ........... ......................... -----_------_-------- .......................... ................... <br /> ...................... ........ --------- .................. -----------___--------- .............................................................. <br /> ----------------------- ........ <br /> .............. ........ . . ...... ............ ... ...... ....................... ....... <br /> JDraw existing and required addition on reverse side) <br /> . ..... ........ .... .. .... .. <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'aWd"Regulati6ns of the Son Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <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 to Workman's�compeniation laws of California." <br /> Signed ........ . ..... ................Z�� --------------------------- Owner <br /> .................. ------- ------- Title <br /> ............. <br /> By <br /> ?i1fer than owner <br /> F0�J R M�N �UE ONLY <br /> D <br /> APPLICATION ACCEPTED BY --- <br /> BU(LDING PERMIT ISSUED ...... . ... . ------- ... .... . <br /> ADDITIONAL COMMENTS . .... ------ --------- ----------------- <br /> .................. . ...................I.,................. ......... ------­_­-------- ...... ------------------------ ---------- ------- <br /> • <br /> ...........................................................Z ------ ........ ........... ......­----I..__...... ......... <br /> ................................ ......... ..... ................................ <br /> DISTRICT.............................................Dote ... <br /> AN JOAQUIN LOCAL HEALTH DISTRICT <br /> ....... <br /> Final Inspection by. ...... <br /> E. H. 13 241.'68 Rev. 5M. 7/72 3:X <br />