Laserfiche WebLink
I <br />FOR OFFICE USE; FOR OFFICE USE: <br />APPLICATION FOR SANITATION PERMIT -7 <br />Permit No... <br />........ ........... (Complete in Triplicate) <br />Date issued.. 77 <br />This Permit Expires I year From Date Issued <br />Application is hereby made to the Son Joaquin Local Health District for 0 permit to construct and install the work <br />ork herein described. <br />This application is ",!Ode in cOmPhonce wth County Ordinance No. 549 and existing Rules and Regulations-, <br />CENSUS TRACT <br />,RESS/LOC <br />JOB ADD t�TION <br />Phone.. ......... <br />owner's Name Ut <br />city ... t5, �� <br />Address.- <br />Phone ...................... .......... <br />......... License # <br />Contractor's <br />Installation will Wye: Resid n-ce Apartment House 1 Commercial Trailer Court. t -J <br />Motel <br />Other ....... <br />0 <br />........... Lot Size. ­ <br />Number of living units:: -.._.....Number <br />-- ....... Number of.bedrooms ...i;�....Garbqge.Grinder. <br />I <br />Water Supply; Public System and name ........... .... ........... . " ........................... .. Private <br />Character of soil to a depth of 3 feet- S6nd Silt [I Clay ©i peat C, Sandy Loan 7, Clay Loam <br />Adobe r7l'T Fill Matera! -?,-....If yes, type <br />be placed on reverse side,} <br />(PI 'Ing f lot, location'of system in relation to wells, builcling§; etc. -lust <br />,8t plan, �how� size 0ie <br />-Te <br />NEW INSTALLATION- ':(No_ septic tcnk or seepage pit permitted if I:iublic sewer is av0'ilablewithiri 2bb feet <br />'_ <br />PACKAGE TREATMENT' SEPTIC TANK­[t1'­ ............ *05 <br />Ccipocity>.­­i No. Compartments <br />Distance.to, necrest".W-ell­ <br />foundation Prop, Line <br />..-YtTotal Length ........ <br />LEACHING LINE No. of Lines......._ <br />Box...Type Filter Filter Material._....-_..:.............. <br />�.-.,-Foundction .... . ...... roperty Line, --------- - <br />Distance to nearest: Weff 4 "" <br />: Rock Filled,,YegO No <br />SEEPAGE PIT ....... ....... <br />-4 <br />Water Table Depth­r*..1.:1­.-­­­ ... ........ Size. <br />Distance to nearest: Udell_ ................ Foundation LJ <br />ne <br />Date-- ­k <br />REPAIR -'ADDITION Prev: Sanitation -Permit <br />Septic Tank !Specify Requirements)- ....... ....... <br />Disposal, Field (Specify Requirements)' <br />U <br />....................... ... ......................... ... ...... <br />.......... ­ ......... <br />...................------ <br />­ (Drawi existing and required addition on reverse side) <br />I hereby certify that I have prepared this application and that the work will be dons in accordance with Son Joaquin County <br />Ordinances, State Lows, and Rules and Regulations of the Son Joaquin Local Health District. Hama owner or licensed agents <br />signature certifies the following.- <br />MY <br />-I certify that in the performance of the liivoij'fai� which this permit is issued, .1 shall notamp OY person in such 'manner as <br />to become subject to Workman's Compensatiorl. laws Of, California." <br />Signed..'..... <br />(if other than owner) <br />APPLICATION ACCEPTED BY- ­ <br />NOR DEPARTMENT USE ONLY <br />....................... <br />BATE � DA <br />........... <br />DIVISION OF LAND Nurviocr, ........... <br />r.. ,.. y <br />ADDITIONAL COMMENTS ... <br />. .......... ......... .. ........ ....... ......... <br />........... . ...... <br />........... . .. .......... . .. <br />.......... ............ ---------- - <br />.............. <br />Final Inspection by:.- F&S 2107 REV, 7174 3M <br />EH 13 U SAN JOAQU# LOCAL HEALTH DISTRICT <br />