Laserfiche WebLink
------- <br /> .FOR OFFICE; USE: APPLICATION FOR SANITATION PERMIT <br /> Y <br /> ..--•.............................. Permit No. .. S.S..-. <br /> (Complete In Triplicate) <br />...... <br />....................................................... <br /> Date Issued .6.:..a 7.:....y <br /> ......... This Permit Expires ] Year From Dote Issued <br /> Application is hereby made to the Son Joaquin Local Health District for a permit 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 /> JOB ADDRESS LOC ON .. �^ � ------ 1..f�G ;:,e:r-:...........CENSUS TRACT .... ............... <br /> Owner's Name �!L .: �'°C�GP�r ..,p .� ................ . ..................Phone <br /> .... <br /> city t <br /> Address .................. 7 r�7..... ty ....... .............._ <br /> Contractor's Name .....��? .._.. -----••--------------------------License # � .�J. Phone .......... <br /> Installation will serve: Residence UArartment House 0 Commercial❑Trailer Court 0 <br /> Motel ❑Other <br /> Number of living units:__:_ ....... Number of bedroom Garbage Grinder e� Lot Size ..................... <br /> System <br /> Sand Loom [D <br /> Water Supply: Public S stem and name°.............. y�, tr,.fc.h_.�.... . ......... .. <br /> Character of soil to a depth of 3 feet: ,Sand❑ . Silt❑ ;�F�fflMaterial <br /> ❑ y ❑ Gay Loam O <br /> ti' r;Ndrdpan ❑ Adobe /.t) .. if yes,type ........................ <br /> r <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 tdnk`ar seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ } SEP.TICTANK.1 ] Size..............................I.................. Liquid Depth .................. <br /> Capacity t .... Type _--- Material...................... No.. Compartments ......... . <br /> Distance rtalneurest:_Well - <br /> .Foundation ...................... Prop. Line ......................0 <br /> LEACHING LINE ( ] No. of Lines -------------- ...`-. Length of each ine.................. Total) Length __.._............... ....... . <br /> P � ' � <br /> { 'D' Box!.._.._...... Type ................ <br /> Filter Material ....Depth Filter Material ................. <br /> -.-•------..._... _...... <br /> r • - ' <br /> Distance to neoresf: Well .:...................... Foundation __. .................... Property Line ........... <br /> SEEPAGE PIT ['j Depth'. <br /> ...............l iJiameter ........•....... Number ............................ Rock Filled Yes r] No 1:1f $ <br /> Water Table Depth_: --••k•-••-•---••----•-•------------------Rock Size ------•----....-•---•---......._ .� I. <br /> ' Distance to nearest-Well ..'.-___---_--•.......................Foundation ............ Prop. Line ........... .......... <br /> REPAIR/ADDITION(Prev. Sanitation Kermit�# <br /> .... •-----------------------•---------. Date .:.._.....---......------....:_:} <br /> Septic Tank (Specify Requirements} ....... ........... J,. ... .._ �i...ef .- ........ <br /> f <br /> Disposal Field (Specify Requir ments) :: <br /> ........ ................................ <br /> /f <br /> p ..C��.:----•"'Y•----- -ice- -- ----- ....... :�}t�• ...-, <br /> UQ .......--•............................................................................... <br /> ................... ..........................-----_..... ............... ..... rt - <br /> (Draw existing and required a_ddition on reverse side) <br /> I hereby certify that I have prepared this application andxthat the work will be done in accordance_with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son,.Joaquin Local Health District. Home owner or licen. <br /> sed agents signature Certifies the following: <br /> "I certify.that iW.the performance of the work for which this permit is issued, l shall not employfany person in such manner <br /> as to become subject to Workman's Compensatio.ri taws`of Califernid:' <br /> Signed ....... . ................................:..................................... Ownerc � <br /> B �� <br /> y Title '` <br /> (If of er tha •owner} <br /> ` FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -- -- -•.{� ...---•-- ` = -_._ . DATE .�� .- � ,,7r ..'............. <br /> BUILDING PERMIT ISSUED J ...........DATE <br /> ADDITIONAL COMMENTS <br /> f . ' <br /> .............................. ... .................... :.................................. <br /> ...-•---........,:--,---.-........................------... ............. <br /> •----- ---•----------- <br /> --.....--•--•--•-•--------•--••. <br /> . ---• .....:._Date �a <br /> Final inspection b �--�G-••- --•--:F. .... ----•--=--•.........................•-- ;----- •• � •� ���...........---- <br /> � ` AL HEALTH DISTRICT <br /> //6 Y-lae - SAN JOAQUIN:LOC CO [ <br /> L1� I <br /> r. u 13 24 I.-AR pe„ 5M 71723-m <br />