Laserfiche WebLink
FOR OFFICE USE; <br />.......... ............. APPL(afiON FOR SANITATION PER Mff <br />........».... .... ....... ........ (Complete In Triplicatel NO. <br />...............• ...---- This.ftrinit Expir*s I Year From Oat* issued <br />Application is hereby made to the Son Joaquin Local Health District for a permit to con*Ud atVd install the work herein <br />described, This application is made in compliance with County Ordinance No. 549 and existing Rules and <br />Regulations; <br />JOB ADDRESS/LOCATION TRACT <br />Owner's Name ps .. ...... ­ aNSLIS --------- <br />Address ...... ........ ....... ­ ............ ­­ ... . .... Phone <br />3tP <br />d. <br />......... City ..Ac <br />Contractor's Norne­0,Sij,!.!,W ALMPA-- <br />--- ­­­­­ ------ ­ -----­--­-------------- <br />....License # Phone <br />Installation will serve-, Residence El Apartment House 0 Commercial VTraller Court <br />Motel C1 Other ......... .. <br />Number of living units;..?.-..Number of bedrooms -....Garbage ., Grinder ..... . Lot Six& <br />Water SuppJy. Public System and name ..... wAt*r,.wP-j1 <br />Character Of soil to a depth of 3 feet.. Sand C] Slit Clay [I Peat C] Sandy Loom Clay- Loom <br />Hardpan JC_ Ad.obeo Fi.JlMaterio) ... ..... If Yes, ----------------- * <br />{Plot plan, showing size Of lot, location of system In relation to wells, buildings, etc, mu 11 st be placed on reverse sides <br />NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer Is available within 200 feet W <br />PACKAGE TREATMENT [ ] SEPTIC TANK ffl )d <br />COPOcitY490 .... ­.. . Type A-115.Z30 Liquid Depth <br />Mjt­ AAciterial...,.10.n.C.XV.tdNo. Campo rft <br />Distance to nearest.. Well ­ rtme ........... <br />LEACHING LINE Foundation ...-1.0.x_._.-.-.-- Prop. Lito .... ..... ........ <br />No. of Lines Length of teach line-...:4.. .1�­-'-­ � ----- Total LenWh ­AO! .... . .. <br />`D' Box ... A.­­ Type Filter Material -Waghp Depth Filter Material .159,ik <br />Distance to nearest: Well ..............loot — --------- <br />.jEEPAGE PIT Depth ­­��§­' ....... ...... -.4niotion ­­ .. . ....... .... property Line - ............ ......... <br />Diameter --- Number . .1- ---------- . ..... Rock Filled Yes (3 No <br />ip <br />Water Table � Depth .�- I -­ ..... ­­ � .............Rock S1:re.­­­....... <br />­.­­ <br />Distance to nearest. Well ­­=.....1.0Q ..... Foundation <br />REPAIR/AI)DITION(Prev, Sanitation permit#. hop. Lue <br />... ­­­ --- - ----------­--- - - - ---- - Date ... <br />Septic Tank (Specify Roquiremen'ts) .... .......... <br />Disposal Field ISpecify Requirements) . ...... <br />........... I . .. . ............... ..............,_.....«......... .... . .. . . . ............. <br />................ ­..""..­ ............... y.._ '..1St......._... ........... ­ ...... ­.t,;:­-.­ .......... <br />(Draw existing and required addition on reverse iiiiii <br />I hereby certify that I have prepared this application and that the work will be done in accordance with Sm j"qW" <br />County Ordinances, State Laws, and Rules and ROSVICIla"s of the Son ""min Local Health 0101rid Home ow"ft of am"- <br />sod agents signature, certifies the following- <br />III certify that In the p4orfort"anc& of the work for which this Permit is issued, I SWI not wnploy ony porgon in fma manner <br />as to b0c'"" sublOct to Workman's Compensation laws of collfomla,­ <br />Sign <br />w ­ ... 1 1­ ';tg'tj'­ --- Owner <br />EY ... <br />at <br />t n netitle <br />DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY <br />BUILDING PERMIT ISSUED—— .......... .................................... DATE <br />.............. ** .... .. ............ DATE­­ ............ <br />........... ...... ...... .......... I .................... . <br />................ <br />ADDITIONAL COMMENTS .......... .............. ........ ....... <br />.......... .......... <br />. .. . ...... . ............ .... . ........ . . <br />.......... <br />.. ....... ...... .... ... ..... . .......... <br />---- El'-4-A <br />:1 Inspection by, <br />lle:e ............. ............ ........ <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />E. K 9 T-`68 Rev. sM <br />