Laserfiche WebLink
FOR OFFICE USE: <br /> APPOCATION FOR SANITATION PERMIT <br /> Permit No.. -72---3-0... <br /> (Complete in Triplicate) <br /> ------------------- ------------- --------------- <br /> Date Issued <br /> ----- ------------ ---------- ------------------------- - This Permit Expires 1 Year From Date Issued <br /> Applicatio5n 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/LOCATION . --------)------t---------- <br /> ---------- --- -,C---�- <br /> ------------------------ ------------------------- -CENSUS TRACT -------------------------- <br /> Owner's .Name --- 470a--ec— 7----------------------------------------------------------Phone '----------------------------------- <br /> Address ------------------ I <br /> 4P=q--- --------- - --- ------------ -- ---------- city ----- —-------------------- <br /> -------------------- <br /> Contrazt�o-r:shame`------------ P ---- Ph ---------'. <br /> --------------I----- ---- --------'%---------------------------------------License 5 V <br /> -------------- <br /> Installation will serve- Residence impartment House rE] Commercial :❑Trailer Court <br /> Motel F <br /> -1 Otherr. <br /> Number of-living Number of bedrooms Garbage Grindery­e,�-5--- Lot Size ..... <br /> Water Supply: Public System and name -------------------------------- --------------------------------------------------------- Private <br /> Character of soil to a depth of 3 feet: Sand'E] ,-..-Silt C] Clay E] Peat❑ Sandy Loam ,M,- Clay Loam 0 <br /> H'ardpan Adobe"=I Fill McIterialAJ 0-- If yes,type -------------I--------------- <br /> (Plot plan, showing size of lot, location of system in 'eelation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,),/, <br /> PACKAGE TREATMENT SEPTIC TANK e----- ---------------- Liquid Depth <br /> ------------ <br /> Capacity .) <br /> Type <br /> ---2--material- No.._Compartments .............. <br /> Distance to nearest' Well ----- I---------------Foundation --------- Prop. Line .�---------=--- <br /> CHING LINE LINE fy No. of Lines Length of each Iine--<��,�---6-57-- Total Length ........... <br /> D' Box -- '—'5�Type 4 Filter Material 424-cAr--Depth Filter Material ------ t--- ---------------- <br /> D!itance­1Y,!nea;e'st: Well -- ------------t- Foundation ------------- Property Line -----------------­----- <br /> SEEPAGE PIT Dia,rrjaer ------- Number - --- -------------- Rock Filled Yes No <br /> bX <br /> Water Table Depth ------------- ----------------------- <br /> ---------Rock Size ---- -------------- <br /> Distance to nearest: Well --------- ----------_-------.Foundation Foundation ------- Prop. Line -------------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit • -- ------------------------------ ---- Date ---------------------------------- <br /> SepticTank (Specify Requirements) --r--------------------------------------------------------------------------------------------------------­­-------------------------- <br /> Disposal Field (Specify Requirements) ----------------------------------------------------------------------------------------------------------------------------- --------- <br /> --------- -------------------------------------------------------------------------------------------------------------------------------------- ------------------- ----------------------------------- <br /> ---------------- ----------- -------------- <br /> taw <br /> -------------------------------------------_ -_k__ti�`_____ <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 San Joaquin LocalHealthDistrict. 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 ----------------------------------------- ----- --- ------------------------------------------ Owner <br /> By - ----- -----------(If--other---------than n <br /> _an__o-- ----- - - ----------------- Title . ...... <br /> er <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ---- -------- -- ... DATE ----------;.7 -- ---- <br /> BUILDING PERMIT ISSUED -------------------- --- ---------- DATE ------------------------------------------- <br /> ADDITIONAL COMMENTS <br /> ----------- ------------------------------------------------- -----°------ -------------------------- <br /> ----------------------- ---------------------------------------------------------------- ----------------------------------------------------------------------------------- --------------- <br /> -------------------------------------------------------- ------------------ <br /> ----- ------ --- <br /> - --------- <br /> Nnaflns,pectio6,by: ------------------------------------------ ------------------------------------------------------------ <br /> ----- --- ------- --------------------- - --- - - -------- ---------------------------------Date ----- --- ------------ <br /> SAN J 0AQ U I LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />