Laserfiche WebLink
FOR OF-ICE USE.. APPLICATION FOR SANITATION PERMIT <br /> -------------I------------- ----------------------- <br /> --------------------- (Complete in Triplicate) Permit No., 7-1--3, <br /> ----------------------------------- This s Permit Expires 1 Year From Date IssueDate Issuedd <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 ADDRESS/LOCATION --------- e <br /> -A _v--—---------ikx --------- ------------- -CENSUS TRACT S-0 <br /> Owner's Name ------- --------------- <br /> --------- <br /> --------------Q)-e-Vl-----U.-A.:11A------------------------- ---------- -------Phone <br /> --------- 7ly <br /> - <br /> Address ---- --- _,3_3 , 5- - <br /> _S_`--------------------------------------------- <br /> a --­. city ------- ---------------------------------------------------------- <br /> Contractor's Name ------------:,-------_License # P-hone <br /> installation will serve, Residence <br /> Apartment House,[] Commercial :[:]Trailer Court D <br /> Motel E]Other <br /> Number of living units:.---- ------ Number of bedrooms _-_: _____Garbage Grinder Lot Size - --- -------------------------------------- <br /> Water Supply: Public System and name ---------I--------- <br /> --Private <br /> Character of soil to a depth of 3 feet: Sand'El Silt 0 Clay El Peat 0 Sandy Loamy�Clay Loam 'E] <br /> I <br /> • <br /> Hardpan ❑E . Adobe [D � illcterial --- J <br /> - If yes, pe -M ----------z�------ <br /> (Plot plan, sh6wing-size of lot, location of system in relation towells, 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 Size----- -I Liquid Dept - -------------- <br /> ---------- h -----V_L' <br /> Capacity ---J_:WQ.49-� Type Material----C.e__wLP,-A_ No. Compartments 1. - I --- -------- <br /> Distance to nearest: Well ------_,3Q_`--------------------Foundation� _ <br /> � J0------------- Prop.L Line -----r$____•_-..._ <br /> LEACHING LINE No. of Lines --------4------------- Length of each line-------76---------------- Total Length <br /> X , 1-1------------ <br /> D' Box _---1.___._ Type Filter Material ----1_96_"_&A_ Deptth Filter Material -----x-w-------------------------------- <br /> Distance to nearest: Well ----VW------------- Foundation ----------- Property Line -___1P.--_____ 7----- <br /> SEEPAGE.PIT, A Depth 4X Diameter ---------------- Number ---_.____._a___----_.____ Rock Filled Yes Er No .0 <br /> Water Table Depth --------),5-' <br /> --------------------------------Rock Size <br /> Distance to nearest; Well -----_--t_ IF <br /> ------------------------Foundation ----ao---------- Prop. Line ---)_S7_..___---_--. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------- —----------I---------------- Date ---------- ----------------- <br /> Septic Tank (Specify,Requirements) -------------------- - - <br /> -------------------------------------------------- <br /> ----- <br /> ----------------------- <br /> Disposal Field (Specify Requirements) -------------------t <br /> ----------------------- <br /> ------------------------------------------------------------------------------------------------------- ------------------------------------------------I ------------------------ <br /> ---------!---------------------------------------- -------------------------------------------------------------------------- <br /> ----------------------------- --------------------- <br /> -'(DraWexisting and required addition on reverse sfdi) <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 shallnotemploy any pers6n in such manner <br /> as to become subject'to Woirkman's,Compensation laws of California." <br /> Signed -- ----- � - -------�----- ----------------------- -------------- wner <br /> _ <br /> By ------------------------ --------------- Title ------ ------------------------------ <br /> A <br /> (if other than ne <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------ <br /> ------- ------------ DATE <br /> ---------------------------------------------------------- <br /> ADDITBUILDING PERMIT ISSUED ------ ---------------------------------------------------------------------------------------------------DATE <br /> IONAL COMMENTS ------------- ------------------------ -- --------- ---- --- ---------- --------------------- <br /> -71 <br /> - ----------- <br /> -- ---- - ----- - -- <br /> - - ------------------------------ ----------------- ---—---- <br /> ------------------------------ --------- - ------- - ------------------------------- ------ -- ---- -- - ------------------------------------------------------------------------------------- -- ------ <br /> ----- ------------- ------------------ - ------- -----------------------------I-- ------- ------ --- -------------- ------ ------------------ ------------------- --- --------------- - ----- <br /> -------------------- ----------------- - - - ------ ------- ---- ---- ---- <br /> Final Inspection y: -- ----- --- - ------------- -------- ----------- - --------- • -----.Date --------- <br /> e----------------- <br /> SAN JOAQUIN LOCAL HEALTH "DISTRICT <br /> E. H. 9 1-'68 Rev, 5M <br />