Laserfiche WebLink
FOR OFFICE USE. <br /> APPLICATION FOR SANITATION PERMIT <br /> --------------------_1------_--------- <br /> - <br /> {Complete In Triplicate) Permit No. <br /> ........--•---.....----••••••--••---...... <br /> ........ ............... ........ ...................... This!Permit Expires I Year from Date Issued <br /> Doti Issued. ....... . .ys. <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 Regulotionss <br /> JOB ADDRESSAOCATION . .��J 7- <br /> ...........CENSUS TRACT ....... ............. <br /> "V <br /> k,-77 - r <br /> Owner's Name ........................................ ...... .............Phone ............. <br /> Address --------- .......5... 7T.4-_-_-- --- -- ...... ----------- ...........City ........... ...... ...... .............. ............. <br /> ........... <br /> Contractor's Name .------- . .. ... . ... .......... Phone . <br /> _11T 71-& ....License# V <br /> Installation will serve: Residence[]Apartment House 0 Commercial OTroller Court 0 <br /> Motel0 Other ....... .................................... <br /> Number of living units:_.-- --..__ Number of bedrooms,.4L....Garbage Grinder ............ Lot Size ............................................ <br /> Water Supply: Public System and I fl. � <br /> home ........ ................... .................... ..................................... <br /> ....... -.............Private 11 <br /> Character of soil to a depth of 3 eet. Sand[] Silt Clay.[:) peat[] Sandy Loam C]. day Loom 0 <br /> Hardpan 0,." Adobe 0 FillAGerial ...... If yes,type ............... ............ <br /> (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc, must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic s <br /> tank or seepage pit permitted If public sewer is available Within 200 feet,)I ot�111 <br /> PACKAGE Taa REATMENT SEPTIC TANK ,#q Size_.7... .../...p............ Liquid Depth ...Y_. <br /> .................. <br /> Capacity ..... Type Material... ...... No. Compartments ............ <br /> A- <br /> Distance.to nearest: Well ....................................Foundation ...'I.P............. Prop. Line....A,(Z........ <br /> LEACHING LINE, No. of Lines -----------_-•... Length of each line.....4�........................ Total Length ............................. <br /> VV %A <br /> 'D! Box ----- Type Filter Material .......Depth Filter Material ............................................. <br /> I <br /> Distance to nearest: Well ------------------------ Foundation -.1......... ........ <br /> Property Line '........................ <br /> SEEPAGE PIT "Depth .... -------------- Diameter ................ Number --- ........................ Rock Filled Yes 0 No C1:010 <br /> Water Table Depth ... -----------------_--------_..............Rock Size • ......................... <br /> Distance to nearest: Well ................................ .......Foundation ............:.t..... Prop. Line ...................... <br /> REPAIR/ADDITION lPrev. Sanitation, Permit# .................. ------------------ <br /> i <br /> Septic Tank (Specify Requirements)...................................................•....------------. --...-- <br /> .................................. ........ <br /> Disposal Field (Specify Requirements) ................................. --------- <br /> ................:---------- ......... ............. ........................ ...... <br /> ----- <br /> ---- ---- -- <br /> - -------------------------- --•..._._..••-••--•--•--••--•...-•--•--••---..... <br /> -------------------------------------- ----------I------ ­----------------- <br /> -- ..................... <br /> ..................... -------------------I­-------------I <br /> --------------------------------------- ------ ........................... ............. .............................*......... ............... <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared�-d 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 Local Health.District. Homo 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 peiseii In such manner <br /> as to become subject to Workman's Compensation laws of California.,, <br /> Signed -------------------------- <br /> -------------- --- ------- ----------------------------------_--- Owner <br /> By ------- -------------------- <br /> ------------------------------------ -------- ....... ............ Title ..... --------- <br /> (if other than owner) <br /> FORPA R Q RTMENT USE ONLY <br /> APPLICATION ACCEPTEDDATE 7 <br /> ------------------------------------------------------------------- --------- ...... <br /> BUILDING PERMIT ISSUED ................................ ................... ---------------------I—,-------- ---..._DATE -------------------------------------- <br /> ADDITIONAL COMMENTS -------------- ..---..I..._•......... ....... <br /> .............-•----••------...- <br /> i <br /> .....a............ . ------7............. -------W............ ...... <br /> ------------------------------------------ ----_--------_- ---­------­_...................I.....................I—----- -------------------------------------------*.......... <br /> --------------w...... ---------------------------------- <br /> ---------- ----------------- ...................... --------I.................... ..................... .................... <br /> ----------------- -------------- <br /> ---------- ------------------ .................. <br /> ..... . . . .......Date <br /> EH 13 24 1-68 Rev. 5m ............ ab .............. <br /> Final inspection by: ..... 1 <br /> SAN JOAQUINJeCAL HEALTH DI RICT 8/7h 3M <br />