Laserfiche WebLink
FOR OFFICE USE: <br /> APPLICATION FOR SANITATION. PERMIT <br /> ...... .................­_­­...... ......... <br /> (Com, Permit No. <br /> fete Triplicate) . ........... ....... <br /> ....................I........................ <br /> Date Issued --- <br /> ................................................ This Permit Expires I Year From Daielssu'ed <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 ADDRESSAOCATION 40 9!� tj�� <br /> .......... . . ...... ... .... <br /> U5 TRACT <br /> Owner's Name . .. ...;� <br /> ......................... ..................... ..................Phone <br /> Address <br /> . ........... <br /> . ............................License......... ---774.- ... <br /> ............. <br /> # Phone <br /> ............. city --- <br /> Contractor's,'Nome t, In- <br /> Installation will serve- Residence dApartment House 0 Commercial C]Traller Couir,0 <br /> I Motel <br /> Numer <br /> of living units..-..,./..... Number of bedrooms ___Y-.....Garbage Grinder ------- Lot Size ... -------------- ........... <br /> i I <br /> Watebr Supply: Public System and name ...I <br /> ......... ........................._.—....................................................i Private <br /> Character of soil to a depth of 3 feett--2ond!E] ..'Silt 0 ­Clay El Pea't❑ 'Sandy Loom Af Clay Loarii C] <br /> Hardpan C] Adobe-E] Fill M6terial -------__ if y <br /> es,type -----_._:.----•-••----._: <br /> (Plot plan, showing size of lot, location of;system in relation buildings, etc.-must,be.-placed,..oh-"reverse side.] <br /> No septic-tank.:dr seep _J <br /> NEW INSTALLATION <br /> .pit permitted if public sewer is available within 200 feetJ <br /> PACKAGE TREATMENT SEPTIC TANK[ Size........... --------- ;.......... Liquid Depth ........... ........ <br /> Capacity - <br /> --- <br /> Type No. Compartments ......... <br /> Distance to near! Well .....7-��_-----------.._.J�Unclation ........... Prop. Line <br /> LEACHING LINE, No. of Lines ......Aq----------------- Length of each line.__._------------`-.-- Tot' <br /> a it e--ng ........................ <br /> 'D' Box ............ Type Filter Material 7------- Depth Filter 'Material _­, ..... <br /> .... ................... <br /> i V <br /> Distance to nearest: Well .................. Foundation .......................... Property-LiKe <br /> .............I ...... <br /> SEEPAGE PIT, Depth ................. ........... Rock Filled Yes ❑ No <br /> Water Table Depth .............................. ........ ..Rock Size ..._................. <br /> 0 <br /> Distance to nearest: Well _.................... .....Foundation .................... Prop. Line ................ <br /> REPAIR/ADD iTION <br /> (Prev. Sanitation Permit# ............................................ Date ......... ............ ........... <br /> Septic Tdink (Specify Requirements)...................•---••......•------••-•--•-•-•... ._ <br /> .................... ......... <br /> Disposal Field (Specify Requirements) .............................................••-•-•-----_----- ......... .................. <br /> ----------I.............................................................................. --------­------- ................................................­--------------­--I....................... <br /> --------------­­­................................. ............... <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 Son 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 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 ... <br /> ................................/........ ------------------------------------ Owner <br /> By ..... - - - -.._ --------- -Title ................ <br /> other <br /> than owner) <br /> FOR DEPARTMENT USE ONLY <br /> K Ul' <br /> ....................- <br /> ...---•••---•-...... ... ............ <br /> APPLICATION ACCEPTED BY ---- ----- -1 ---- DATE .......... 77:.�5. ...... <br /> BUILDING PERMIT ISSUED ..... .... .... . ........................................ is. <br /> -----_------ ----------------------------------------------------- ......................DATE ...............I--...................... <br /> ­........... <br /> ADDITIONALCOMMENTS ...............................• -------------------_---- ...................Z-......... ................. <br /> --••-•---.._..---•-•-••............................................ .................... .......... ............................................................. ...........­­_­­.................. <br /> --------------------------------- .... ............ ..................................... ...... ..................... ..................... .................... .......... <br /> .1. . . ....... ..... ............ <br /> Final Inspection by ......... ... .. ............................_....-••--...••••-••-•---.......................... ­ --------- <br /> ----- - - -------------I....................I.........I................................Date ..........A7. r-S............ <br /> .6.... ,... <br /> JOAQUIN -LOCAL HEALTH DISTRICT <br /> E. H.1-3 241-'G8 Rev. 5M <br />