Laserfiche WebLink
FOR OFFICE USE. <br /> APPLICATION FOR SANITATION PERMIT " 4 <br /> ---------------------------------------------- t No.­"__1�17_��. <br /> Date Issued <br /> IDApplication is hereby made to the San iJoaquin Local Health. istrict for a permit to construct and install the work herein <br /> described. This application is rnade inicomplianc� wifh Couhty Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCAT1 J_ L <br /> -- --- ---- 164,1/ <br /> Add _05L_ <br /> Contractor's Name <br /> -77License -Phone <br /> Installation will serve, Residence Apartment Housef:1 Commercial []Trailer Court <br /> Number of living units:----- Numbe'r-of - i T � <br /> Character of soil to a depth of 3 feet: Sand'E] Silt C] Clay e[�]—Peat-E]- Sandy-Loom-E]—Cial Loam E] <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 see age,pit permitted if public sewer is available within 200 feetJ <br /> PACKAGE TREATMENT SEPTIC TANK: ....... Liquid Depth -------------- <br /> 77 <br /> 1TY Material --- No. Wripartmen <br /> LEACHING LINE No. of Lines --- <br /> Length of each'_h%ye Total Length <br /> ----------- Type Filter Maierial epth Filter Mdfe' <br /> Distance 'to nearestjWell Ito: Foundation ------------ Proper' 1L1ne-..S... <br /> Septic Tank (Specify Requiremerits) --------------- <br /> ------------- <br /> (Draw existing and required addition on reverse side) 4 <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, �nd Rules and Regulations of the Son Joaquin Local Health District. Home owner orlice'n-' <br /> sed agents signature certifies the f;1lowing: <br /> "I certify that in the performance c� f the work for which this permit is issued, I shall not employ any person in such mann�w <br /> as to become subject to Workman's Compensation laws of California." <br /> wrier <br /> ----------------------------- <br /> -- ---------- - ------ ---------!---- - ------& <br />� <br />, (0 FOR DEPARTMENT USEE ONLY <br /> "rruCA//um ACCEPTED BY <br /> _ , U .~� --- E_ _ - - - — '____ ._ PERMIT .~~.^. _ -____ _ _ ' ---ADD/T|ONAL COMMENTS J —^- -'-DAT ------------------------------------------- <br /> - <br /> '-----'—'---- <br /> --_-_-------'--_. ----------------------------------------------- -_—^---.---�_ <br /> —__-__-''- <br /> - — _'°--- -'--'—_---'--'----_-'-'--'-- ' ----. -' <br />` -----__---_-_—._- -' <br /> -------'—'—' — --_—_---.—�-� .----.—_--'—' --------- <br /> | <br /> -'----'---Rno| Inspection 6y� '--'----'---------'----''--Dote -/ � ----_-- <br /> � ------------ <br /> ----------- <br /> SAN <br /> -_____ <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT � <br /> E. H. V l''68 Rev. SN\ � <br />-�----_ � <br />