Laserfiche WebLink
FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> N Permit No. <br /> ----- ----------- <br />- ----- ----------- --------------------- (Complete in Triplicate) <br /> --- ----------I <br /> -------------------------- -------------- Date Issued <br /> This Permit Expires I Year From Date Issued <br /> ----- --------------------------------------------------- <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 /> -------CENSUS TRACT _ ---------------- <br /> ' <br /> JOB!ADDRESS/LOCATION ----------- <br /> hone--------------------------- --------- <br /> ...... -------------------------------------------- <br /> Owner's Name .. <br /> Address ------- --- -- - - --- - --- -- ------- <br /> , <br /> City # Phone --------------------------- <br /> Contractor's Name --------- --------- *- ----- ------------ <br /> Installation will serve.. Residence Apartment House,171 Commercial Trailer Court '[1 <br /> Motel El Other ----------------------------------- <br /> droomJ-- Grinder Lot Size <br /> Number of living units------ ---- Number of be --------Garba.ge r <br /> I I - Private <br /> Water Supply: Public System and name ---------------------------------------------------------------------------1:------------- I <br /> Clay E] Peat [:] Sandy Loam /---Clay Loam 0 <br /> Character of soil to a'depth of 3 feet: Sand'C] Silt F1 <br /> Hardpan ❑F-� Adobe-F� Fill Material If yes, type ---------------------------- <br /> V <br /> ion to wells, buildings, etc. must be placed 'on reverse side.) <br /> jplotf Plan, showing 'size of lot, location of systems injelat <br /> NEW INSTALLATION- JNo septic tank—or—seepci-ge—pit pi-r—rr�ffitte-dif'�Ublic­'sewer is avail6ble within 200 feet,) <br /> PACKAGE-TREATMENT [ I SEPTIC TANK'[ ) Size--------------- ------------------------------ Liquid Depth ---------------------- <br /> No. Compartmelts --------------------— <br /> Capacity --- Type ------------------ Material-------------------- <br /> ------ --------- <br /> t Distance to nearest: Well -------------------------------------Foundation ----------- <br /> ----------- Prop. Line --------------=-.------ N IN <br /> -I in Total Length ------------ ------ ........ <br /> LEACHING LINE No. of Lines ------------------------- Length of each --------------4- <br /> D' Box Filter Material ------------="-------Depth;,F.ilter Material ---------------:-----------------------------, <br /> ----------- Type <br /> . <br /> Distance to nearest. Well ------------------------- Foundation ----------------------- PropeFiy <br /> Line- --------------- <br /> --N"-----lo-e7-:!7--l��I77 Rock lled Yes C] No [I <br /> SEEPAGE PIT ;[j Depth -------------------- Diameter ------------ um I I----- <br /> ------- -AockSize ---- p <br /> Table Depth ----------------------------- <br /> ---------------------- <br /> -------Foundation ----------------A---- Prop. Line <br /> Distance to nearest: Well ------------------ <br /> ---------------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------------------- - ----- Date -------------- <br /> ---------------------------- <br /> Se ---------- ------------------- --------- ------------ -------C <br /> ,ptic Tank Requirements) <br /> Disposal Field. (Specify Requirements) ---- ",Z------- <br /> 4 ---- v- -*7�1�-- ----Ao�- ------ ---- ---- - <br /> ------------------------------ <br /> - --------------- ---t------------------------------------------------------------------------------------------------------------------------- <br /> --------------------- (Draw existing and required addition on reverse side) <br /> done in accordance with Son Joaquin <br /> I hereby certify that I have prepared this application and that the work will be do <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> .1 certify that * the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> ' <br /> as to becoamsu ject'to Workman's Compensation laws of California." <br /> Owner <br /> SigYned ------- ------ ------------------ --- ---- -------------------- <br /> ----------------- <br /> B -- ------ -------- Title -------- 7 <br /> ------ ------C---- ------ ------I--------------- <br /> (If other than owner) <br /> .05 FOR DEPARTMENT USE ONLY <br /> 9, DATE ----------`. <br /> ------------- <br /> APPLICATION ACCEPTED B�f —------------------------------------------------- <br /> i --- <br /> BUILDINGPERMIT ISSUED -------------------------------- -------------------------------------- ----------------------------------DATE -- ----------------------------------------- <br /> ADDITIONALCOMMENTS -- ----------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------- <br /> I ----------------------------------------------------------------------I---------- <br /> --------------------- <br /> -------------------- - --------- -- ---------- ----------- ------- <br /> - - -- -- --- -- - ------------------------------------ ----------------- ------- ---------------------- <br /> ------------------- ------------------------------------- <br /> --------------------------- 'Ai —------------------------------------------ -- ---------------------------Date -------------------- ------- -------- <br /> --- <br /> Final Inspection I <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />