Laserfiche WebLink
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
FOR OFFICE USE: <br /> vn APPLICATION FOR SANITATION PERMIT <br /> ..........................I........ <br /> SAF <br /> (Com pleto In Triplicate) Permii No. ....... <br /> ...................I...................... <br />............................ .......... ......... This Permit Expires I Year From Date Issued Dat6l sued <br /> Application is hereby made to the Son Joc�iqujiri Local"Health,District-fo'r '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 ................................................CENSUS TRACT ........ ...... ......... <br /> .rle_in <br /> Owner's Name 'r .....4�/vv. ............................... ............__.........Phone................................ <br /> Address <br /> -1-1................................ .................. city ........ <br /> . ......... �W. --4&A ........ <br /> Contractor's Name ..../ P//_r__'.7 ee Alflo....................... ..License # ,V-44SW... Phone--.,,'a--­ <br /> Installation will serve: Residence$Apartment Housed Commercial E3Trailer Court 0 <br /> Motel [-]Other .......... ...................... <br /> Number of living units:_.._/.... Number of bedrooms .-'2.-..".Gorbage Grinder Aee... Lot Size aO_IX.A�Ze <br /> .................. <br /> Water Supply: Public System and name ......G._4?/w! -- ------------------------------------Private 0 <br /> Character of soil to a depth of 3 feet. , Sand 0 �Silt❑ Clay El Peat 0 Sandy Loom 0 Clay Loam 0 <br /> Hardpan ❑ Adobe Fill M6terial ............ if yes,type .............. ............... <br /> (Plot plan, showing size of lot, location of. system <br /> in,relation to welIS"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 f Size......._._.................................. Liquid Depth .......................... <br /> Capacity ................. Type ------- ........... Material-----_---..-------.. No. Compartments <br /> ................. <br /> Distance to nearest.- Well ....................................Foundation ....................... Prop. Line ...................... <br /> LEACHING LINE t J No. of Lines -----------------•...... Length of each line.__........_.._....._.____.. Total Length ............................ <br /> 'D' Box ............ Type Filter Material --------------------Depth Filter Material ............... ........................ <br /> Distance to nearest: Well .....__----------_- Foundation _....... .............. Property Line ..._................... <br /> ''SEEPAGE PIT Depth .................... -Diameter ................ Number ------------_- ............ Rock Filled Yes [:3 No C3 <br /> -Waterjoble Depth ........ ........ ............................Rock Size ......... ...................... <br /> Distance to nearest. Well ... ....................................Foundation ............. Prop. Line ...................... <br /> REPAIR/ADDITI-O'N'(Prev. Sanitation Peimii# 1..............................:............ Date ....... .......................... <br /> Septic Tank {Specify Requirements) ....... ... ------­--------- <br /> -. r F . ....­ I el _. <br /> Disposal (Specify'Requirements) ------- <br /> // <br /> al Field (Spect . 4;V-0044e �Z.V <br /> ............ ....... <br /> ---------------­--------- ..................... .................------------------------------------------- --------------------------...........:---------- <br /> (Draw existing a nd required-addition on 'reverse side) <br /> I hereby certify that I have prepared this application and that the r work will be done in accordance With San Joaquin <br /> County Ordinances, State Laws, and Rules amd,Regulations of the Son Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the followitigS <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 ........... ....... .. <br /> . ................ ...... ----------------- Title x......__.... <br /> .................. <br /> (if an owner) <br /> R, DEPARTMEK!;NSE ONLY <br /> APPLICATION ACCEPTED BY . .. .. .............. .............................. ....................... DATE .............................. -------- <br /> BUILDING PERMIT ISSUED .................. <br /> .........I........ ............................ ..........................= `.DATE DATE -------11................................. <br /> ADDITIONAL COMMENTS .................................................. . 1�,� 1 <br /> .............................­­...................... <br /> -------------------------------------------------•-••--•---•... ..... .................. ---- --- ....... ........ ......I........................................................................ <br /> --------------------------------------------------- ..... .......­­............ .......... .. .. ....................... ................ ------ <br /> ............................ <br /> .. .. ..... . ......................I....... ...... <br /> 4d-_1 4 1 <br /> Final Inspection by X ..... . . <br /> ..................Date ... 7------ <br /> SAN JOA I L E DISTRICT <br /> E, H.13 24 1-'68 Rev. 5M 7/72 3 24 <br />