Laserfiche WebLink
FOR OFFICE USE: <br /> APPLICATION POR' SANITATION-PERMIT <br /> ----- Permit No. <br /> -- - <br /> -------- - ---=--- (Complete in Triplicate) <br /> k <br /> ------- ----------- ----------- - i <br /> ------------- ate _4-30.< <br /> -----------------------------------------:--------------- This Permit Expires I Year From Date Issued <br /> DIssued <br /> Application is hereby made to the tan Joaquin Local Health District for a per'mit 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 /> .2 G 0 ------------10�v jE. C-------- ---------- <br /> JOB ADDRESS/LOCATION ._.__ - -------------E ---------- --E7 <br /> JU,�r7 I�_' <br /> — -------- A ----------------------------------- --Phone --`--------------------------------- <br /> Owner's Name ------- <br /> V1 -------­­ City I- .......... <br /> Address -------------------0- __�.5 �, ) ----—----------------- ----7---------------------- <br /> Contractor's Name &T.-F. ------ --------------.- Phone ----------------------------_ <br /> # <br /> Installation will serve: Residence ❑ Apartment.-House F �railelr Court 'E] <br /> Co'�imercia! <br /> Motel F-1 Other ----------------------------- <br /> ----------- <br /> Number of living units:_.___._--+—Number of bedrooms"—..Garbage' Grinder ------_.- Lot Size Water Supply: Public Systeml.and name_ ----------------------------------- ---------------------­­------------- ----- ----------------- -------.-Private E] <br /> ��.!Peat,-[j Sandy Lo <br /> Character of soil to a depth 6'f.3'.feet: Sand `10ciy am 'F]Clay.Loam E] it <br /> - <br /> tHardpan F1 Adobe F] Fill Materici-il-iV 4 yes, type ----------- <br /> -------------- -- <br /> (Plot plan, showing size of;lot, location of-,system t be placed on reverse side.) <br /> in relation to wells, etc. mus <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if p6blic sewer is available within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANKf ----------------- -------------- Liquid Depth --------------------------- <br /> --------------- <br /> Cap6city ----------------- type -------------------- Material------------- No. Compartments <br /> I nDistance to nearest: Well ------------------------------------Founclatio Prop. Line -------------------- <br /> s -�th ---------------------------- <br /> LEACHING LINE No. `of Line ------- Length of each line---------------------------- Total Len <br /> 'D' Box Type Filter Material ----------- •--'Depth,Fi I tee, Materibl, --------------------------------------- <br /> i 0- erty' <br /> Distance to nearest: W61:14­�___ _ �d on' p, <br /> u ti �r6 Line- ------------------------ <br /> SEEPAGE PIT Depth -----I_____________ Diameter ---------------- Number ------- -------------------- Rock Filled Yes No [] <br /> Wat.6r1TdbI`e-'Depth --------- _-_I---- -Rock Size <br /> Distance to nearest..Well -------- =_,------.---------- Foundation -------------------- Prop. Line ---------------------- <br /> REPAIR/ADDITION(Prev. Sanitation.Permit --------------------------------------------1-- Date ---------------------------------- <br /> 77�Septic Tank (Specify Requirements) ---- -------------------------------- --------- - ------------------------------------ ---------I.,-------------------------- <br /> 6-F--- <br /> - -------------­--------------- <br /> Disposal Field (SpedifTRequirements X--/e I --------- <br /> --------------------------------------------- ------------------------------------------------------------------------------ <br /> ----------- ------ -------------------------------------- ------------------------- — _/ ­ ,— , — - . - I i <br /> ------------ac� --------------------------------------------------------------------------------- <br /> --------- ---------------------------------- ----- --------------------- <br /> (Draw existirig.aiid require-d'addition on reverse side) <br /> I hereby certify that I have prepared this applic'aition 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 District. Home owner or liven- <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 noi employ 6inj person in such-nianner <br /> as to becom subject to Work6m�$_gompensatioh`-laws of California.'i' <br /> Signed <br /> ------------------------------- Owner <br /> -- <br /> By --------------------- ---------------I---- ------------------ z------------- <br /> --------------- Title --------------- --------------- ------- ------- -------------- ----------- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> DATE J.' <br /> APPLICATION ACCEPTED BY ------- A B ------�-------- ---- <br /> BUILDING-PERMIT--ISSUED'—------ ------ ---- ----------- ------------- <br /> ................ <br /> 0 ----------- <br /> R bQ1 F <br /> ADDITIONAL COMMENTS ------ V i <br /> WZ-1 gi p------ - -I- --------- - <br /> ti <br /> ------------------------ ----------- <br /> ----------- ---- ---- ----- ------------------------------------------------------------ <br /> --- --- ------------------------------------------------- - <br /> --------------- <br /> ---------------------------------•-- --- ---- ----------- <br /> ---Vie n;?-',-- ----------- <br /> e4 f I L------------------------Date <br /> Final Inspection by. - -- ------ <br /> SAN JOAQUIN LOCAL HEALTH DISTWT <br /> fi <br /> E. H. 9 1-'6B Rev.5M <br />