Laserfiche WebLink
FOR OFFICE USE,. <br /> .......... ............11----------------------- APPLICATIQN. SANITATION PE WIT <br /> ...... <br /> ;Complete I Tripucatol Permit No, 2 <br /> ............................. —e 7 <br /> ........................... ............ ........... This Permit Expires I year from Date Issue' Date Issued .1 J- <br /> d <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/LOCA ION Cq 1 ... ....... ......... ......CENSUS TRACT ...... ......... <br /> Owner's Name A7 . ............................... ................... .. ... ... one <br /> Y <br /> Address <br /> -&CZ <br /> ... --- - ---------------- ......I city <br /> Contractor's Name .... <br /> #- License <br /> 7!P. Phone !H//P.Y ­. <br /> Installation will serve: Residence Apartment HouseO Commercial C]Troller Court <br /> Motel 0 Other__..._f__..-..... <br /> Number of living units:..._- ----- Number of bedrooms <br /> 3­­Garbage Grinder ..... ...... Lot Size <br /> Water Supply: Public System and name ------- .......... ...... <br /> ........ .......... ...................................... ................Private <br /> Character of soil to adepth of 3 feet: Sand Silto . <br /> CIOYO Peat Sandy Loam o Clay Loam;m <br /> -Hardpan 0 Adobe 0 Filrkaiei! <br /> pe............... ............ <br /> (Plot plan, <br /> showing size of lot, location of system in relation to wells, buildings, etc, must be placed on rovers Ide N <br /> NEW INSTALLATION. (No septic tank or seepage pit permitted If public sewer is 'table within 200 feet,) <br /> V. <br /> PACKAGE TREATMENT I ] 1 7 , I /oval <br /> SEPT C TANK f ] <br /> Size...../.%?z90."-- .(1 <br /> Liquid Depth ..V......... ............ <br /> Capacity -------------------- Type .................... Material----------------­--- No. Compartments <br /> Distance to- nearest: Well -----­-------­-- ......­..Foundation ...................... Prop. Line ......... ......... <br /> LEACHING LINE No. of Lines t---------- --- Length of each Iffln <br /> ............. Total Length ............................ <br /> V Box .......I..... Type Filter Material filter Material xvl� <br /> I .......*.......1...... ............. <br /> Distance to nearest: Well ­.Ife------- ... Foundation F <br /> )D..... ....... Property Line ........... <br /> SEEPAGE VIT Depth .......4......... A 4 <br /> -- &Iam, eter ............. Number --------------­----- Rock Filled Yes 0 No 0 <br /> Water Table Depth ---- ......................... .................Rock Size ................................ <br /> Distance to nearest. Well ......................:f..--..----_ . Foundation .................... Prop. Line ...................... <br /> REPAIR <br /> GkEPAIRJjjN v. Sanitation' Permit <br /> DDITIO .... ............. Date ­-------- - -- ...... <br /> PeC4 <br /> ......... . <br /> i.c <br /> /.1�� - <br /> 7---------- <br /> Pecify Requirements)............. . ......... <br /> ------------------ ................... ---- - - <br /> Disposal Field (Specify Requirements) -------- ........ ................ <br /> ----------­---------------------------------- <br /> -----------------------------------------------------------------I--------- -------------------------­--.............. .. ...............w...........I....... ............... ...... ......... <br /> 'lDraw existing and required addition on reverse-side) <br /> I hereby certify that 1!have prepared this application and that the work will be done In accordance with Son u'" <br /> 'Joaq'fro <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local HOC11W 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 shall not employ any person In such manner <br /> as to become subject to Wairkman's Compensation laws of California." <br /> Signed -------------•- <br /> - ------han ------**-- ---------- ---------------------­----­-- Owner <br /> t <br /> -------- --------- --------- Title ... <br /> ------­------- ............... <br /> owner) --------- ------- <br /> Ii other <br /> FOR DEP T USE ONLY <br /> APPLICATION ACCEPTED B <br /> BUI P T ISSUED <br /> ... --------- <br /> - - ----- DATE <br /> BUILDING PERMIT ISSUED <br /> ADDITIONAL <br /> A I '.. .......................I ............... ------------------------­----- -- .......... DATE ... ................ <br /> COMMENTS <br /> ---------------------------------------------- --------------------­ ...... . .. ....... . . <br /> .............. <br /> ADDITIONAL COMMENTS ——, <br /> -------------------------- ----I.........­­.............. ........... -------- <br /> - <br /> -------- <br /> ---------- ---------­....... ------- -------------- ...................... --------------------------------------- <br /> ------------- .......­� -------- <br /> ................. -------- - -------­............ ---------- ................................ <br /> -------- -------- -----------­----------- ------------- <br /> ------------ ....................... D <br /> Final Inspection by. .......... <br /> a - •.... <br /> EH. 13 2h 1-68 116, 5H .......**...............*---------15 ?SAN JOAQUIN -LbCAL HEALTH D TRICT �---._...... <br /> 8/7h 3M <br /> 4 <br />