Laserfiche WebLink
FOR OFFICE USE: . I <br /> APPLKATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) -7- f3-/ <br /> Permit,No. ....2............... <br /> ............................................ <br /> ..................................... Doti Issued <br /> ................. This Pernill Expires I Year From Date Issued <br /> Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work heroin <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB .ADDRESS/LOCATION _AAETO.....We a T� .... t,SPA......... <br /> .....CENSUS TRS ._............_....... <br /> Owner's Name ....L 1. <br /> ... PhoneVT-3�&.!; <br /> Address ..............city ...q`~. -Ufa._..... ............ <br /> . C <br /> Contractor's Nome ----02.JX15 9Y.....�z6nT_ <br /> ............ ..........6cense # ....... Phone <br /> histallation wif I serve-. Residence 2'Aportrnent,House 0 Cornmercial:oTraller Court <br /> Motel 0 Othfe�r....... ...... <br /> 'Number of living.units:-... <br /> .... Number of bedrooms _..-•Garbage Grinder ............ Lot Size 31(?.. <br /> ­ F <br /> Water Supply, Public System and name ...................••--•-•--....... _.__----___....-----._._. ....... ................ ...Private <br /> Character of soil to a depth of 3 fe 8_tr, . Sand 2( Silt 0 Clay 0 Peat 0 Sandy Loom ❑ Clay Loam 0 <br /> Hardpan❑ Adobe-0 Z-Fi II2­M6'#6rIaI ............ If yes,type............... ............ <br /> (Plot plan, showing size of lot, location of system in relation-to well.s, buildings, etc. roust be placed on reverse side-1 <br /> I <br /> NEW INSTALLATION- (No septic'tank or seepage pit permitted if public sewer Is available within 200 feet,( <br /> I � <br /> PACKAGE TREATMENT 13SEPTIC TANK I ................ Liquid Depth A....---......---••--- <br /> Capacity �600.14- Type .................... Material QYW,9jd0_ ---- No. Compartments �..................O <br /> Distance-lo nearest: Well ................Foundation _S6.4...... Prop. Llnel�e.. <br /> LEACHING LINE No. of Lines <br /> J"---------------- Length of. each -------- --- Total lengtha.R0 <br /> 'D' Boxwy�"-cType Filter Material ..........Depth Filter Material IZ......plo.c�, ... .......... <br /> Distance to nearest: Well ........ + <br /> Foundation ----------t ....... Property Line ....... <br /> SEEPAGE PIT Depth ---------------------- Diameter ................ Number .........................._ Rock Filled Yes 0 No 0 <br /> Water Table Depth .....................Rock Size ................................ <br /> Distance to nearest: Well ----------------------------------------Foundation .................... Prop. Line ...................... <br /> REPAIR/ADDITION JPrev. Sanitation I.Permit# ............ Date ----------­------------------71 <br /> Septic tank (Spe'cifV Requirements) ....................................................................._.......... <br /> Disposal Field JSpecify Requirements) ,............................................................. ...................................... <br /> .................................. <br /> -------------_I------ -------------------!-----------------------I----------------­----------**---------------------- ------------------------------------------------------------------ <br /> ------------I----------------- ------------------------I--------­---------------- -------------••---....._.---•---------------.,............. <br /> ............................................... <br /> (Draw existing and required addition on reverse sidel <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, and Rules and Regulations <br /> of the Son Joaquin Local Health,,District. Home owner or licen- <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 .employ ,any person In such manner <br /> as to become subject to Workman'; Compensatloit laws of California.".' <br /> Signed <br /> ......------------------------------------------------------------ Owner <br /> By .... <br /> . . ........................... <br /> ----------- ---------- Title <br /> I er <br /> (if other than' wner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - -- - -- ---- -----------I------- --- ----- -_--------------•----..--.._-.._.. DATE <br /> BUILDING PERMIT ISSUED --•----------I---_-__-------- DATE ................ .............. ........... <br /> ADDITIONAL COMMENTS --------------'•--•--._..._..__-•-• ....... ...... ..................................... <br /> ----------------­----- ------1-1..........I ---------------------------- - ------------------------- ................................... <br /> i...I--------I---------------------------------- -------------- ----------- ------------- ............... ----------------------------------- <br /> -------------------•---------------..._.-------------- ------•_-•---.-.-.-....---------------.-...-..-..-•--------•-• <br /> -------------I---- ------------­­------1­--------1-1------1-1------------------ L--------------­--------L----------------- <br /> ------------------------------ ---- ---- - <br /> ------------------ --------'Doi <br /> final Inspection by.. - -- ----- <br /> EH 13 2h 1-68 11,_V. 5M SAN JOAQ N LOCAL HEALTH DISTRICT 8/7h 3M <br /> CC5 <br />