Laserfiche WebLink
FOR OFFICE USE- <br /> 10 APPLICATION FOR SANITATION PERM <br /> ............... <br /> ...........I.......... lCompleto in Triplicate) <br /> Permit No. <br /> Date Issued <br /> ............. ........... ...... ------------- This Permit Expires I Year From but*Issued __............. <br /> 1fa <br /> Application is hereby made to the Son Joaquin Local Health District for a 2- 1 2_0-0/ <br /> 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 /> 0 <br /> V XO -K3o 1'7vvV <br /> _ GJOB ADDRESS/LOCATION .../-... ­A.. � #TACE SUS TRACT .......................... <br /> Owner's Name .... I/ _ 6 <br /> Z_. ,..:.......r---- ------­---- .....Phone ..'V <br /> Address ----4-7.7 .................... ............City ------- <br /> Contractor's Name . .................. --------License --- Phone ................. ............ <br /> Residence Apartment Installation will serve: aa Iment House f] Commercial oTrailer Court 0 <br /> Motel C]Other <br /> Number of living units.--,-_--_- Number of bedrooms _--_.___-_..Garbage Grinder .........- Lot Size1 .0....4ZeAdd ......... <br /> Water Supply: Public System and name ............................I............ .............._­........................................-.....Private 0 <br /> Character of soil to a depth of 3 feet. Sand 0 Silt ] Clay 0 Peat B- Sandy Loom 0 Clay Loam 0 <br /> Hardpan 0' Adobe 0 Fill Material ............ if yes,type............... ............ <br /> (Plot plan, showing size.of lot, location of system in relation to wells, buildings, etc. must be placed an reverse side.) <br /> 1 <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer Is available within 200 feet,) <br /> PACKAGE TREATMENT I ] SEPTIC TANK[ Size------------------------- --------- .......... Liquid Depth ........... <br /> Capacity ------------- ...... Type ---------_--_-_ Material--- .................. No. Compartments ----------- <br /> Distance.to nearest: Well ....................................Foundation ... .................. Prop. Line ...................... <br /> LEACHING LINE No. of Lines --------------- Length of each line.....................I...... Total Length ...... <br /> ............... <br /> 'D' Box ............ Type Filter Material ....................Dept.h Filter Material ............................................ <br /> Distance to nearest: Well .................. ..... Foundation ----- ................... Property Line ......................... <br /> SEEPAGE PIT Depth -------------------- Diameter ----••-----..-.• Number __........._._...I.._..._.._ Rock Filled Yes 0 No 0 <br /> Water Table Depth ................................................Rock Size .........._._............... J. <br /> Distance to nearest: Well ----------- ............................Foundation .................... Prop. Line ...................... <br /> REPAIRADDITION(Prev. Sanitation Permit# . ................. Date .......................6._......I <br /> , ................... ............. <br /> Septic Tank JSpecify Requirements) ......... ZIL .....&�..&-x---- cL......... .............../ <br /> Disposal Field (Specify Regpirerrignts) ------- ........ .......... ............. ........ <br /> --- --- -----------­------ - ------------------ <br /> &. F 4 <br /> ------------- V.Zoee,4� <br /> ------­------­---- -------- <br /> . . ....... . ......... ----------------------I------ <br /> .......... ----------------- ­-------------­-­----------------------- --• -----­-----­- ...... ------------ ......................... <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done In accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Hiiial&DIstrict. Home owner or lic6n- <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 not employ any person In such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ------------------------------- .......... ------- --------------------------------•----••--_.... Owner <br /> r <br /> ----------- ............. Title ------ <br /> llf4other than ow <br /> DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED By----- <br /> BUILDING PERMIT ISSUED - --­-------------------I.......­----­---------------- ----------- DATE --------------_---- <br /> ------ <br /> -----------------_- ---------------------------------------- --------------------------------- - DATE <br /> ...................... <br /> ADDfT10NAL COMMENTS <br /> ----------- -----------------------­-- -- ------------ ..................­­------------------------------------------------- ------ ------------_................ -------- <br /> ---------- ----------------------------- -----------•-•--------.-.-------••---------•-------•----•--• <br /> ------------------------------------------6-------­------­­----------------------•--•....._...... --------........---•-•---------- ........ <br /> ------------------------------------- ------ <br /> ........................ <br /> Final Inspection by: ---------------------C.,: ------ _:­--------------------------------------*------------------------ ----:r <br /> JZ - ---------------------------------- ------- --- ------------..--Da"te .............. <br /> EH 13 2L 1-68 Rev. 5m <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />