Laserfiche WebLink
FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> q Nl� Alz_ <br /> .................................................... <br /> --•.. _4� &", ­, Permit No. <br /> lcompl*te In Triplicate) <br /> ..................................... <br /> .......................................... . This Permit Expires 1 Year From Date Issued Date issued ----.-__---- .. <br /> Application is hereby made to the Son Joaquin Local Health District for a permit <br /> mit 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 .........................................CENSUS TRACT .......................... <br /> Owner's Name -------C�.. iu)............................... ............. ......Phone <br /> Address ............. ty ................... .............. ............. . <br /> Contractor's Name ............A_LV._kt,,W----—-------------- .................................License # .....__.............. Phone .... --------- ............... <br /> Installation will serve: Residence pr Apartment House 0 Commercial OTraller Court 0 <br /> Motel 0 Other ------- ...... ............. ............... <br /> Number of living units_____________ Number of bedrqoyns ----Z.....Garbage Grinder .... Lot Size ...V) .............. <br /> Water Supply. Public System 4o_Q name <br /> -..._.....----•--•-••---•--....._....................................................Private 11 <br /> Sand <br /> Character of soil to a depth of 3 feet: in 0 Silt 0 Clay 0 Peat Sandy Loom 0 Clay Loam 0 <br /> Hardpan Adobe Moo"Fill M6terlal ............ If yes,type............... ............ <br /> (plot plan, sh6wing size of lot, location of system In relation to wells, buildings, ate. must be placed an reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is avoilabl6 within 200 feet,) <br /> ----_--------- -,5.......... <br /> PACKAGE TREATMENT SEPTIC TANK Size_ Liquid Depth ... <br /> :7(j, <br /> Capacity -�Aywpe/A!,r.,O V.. Material.... .. Compartments .......... <br /> 77; ,.1�dw <br /> n, V CLtance. to nearest: Well ....R.0.14-,V----...........Foundation .......... Prop. Line -------- <br /> LXACHINGLINE No. of L,ines ............... Length of each line...... l7............... Total Length ....... ................. <br /> Box '.A.--.-. Type Filter Material/]—.--),."'_Depth Filter Material ........................... <br /> Distancejo nearest: Well ........ Foundation ------1-6-------- --- Property Line ...... ....... <br /> 4-�r Rock Filled Yes No 0 <br /> SEEPAGE PIT Depth ---- - —— Diameter .... .... Number ------------- ------ <br /> ............ <br /> Water Table Depth .-._- ............Rock Size <br /> tv.1 tl� _�rA✓ -P.................... <br /> Distance to nearest. Well -----_----- ..........Foundation .--..(.4...._.... Prop. Line ---- <br /> REPJ/ADDITION(Prev. Sanitation Permit .dv....................... Date <br /> Septic Tank (Specify Requirements) ---------------------_-_ .....------....-..••-.-._.........--•--••.. ,:........ .. ........ <br /> .. -•..--••-••-••----•---.._......._.. <br /> ...................... ...... <br /> Disposal Field (Specify Requirements) _414-7-s" 1-9---- <br /> A 0 <br /> AAr0L_X - ­.-I ----/poi <br /> _ <br /> ---------- �----- ---- , I Xf........................ <br /> _;7-- _$r-,f14-"**... <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 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-shall not employ any person In such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed --- -----q_ �_o_.... .................. Owner <br /> -' <br /> By .......... -------------------------------- -------- .............. ------------------------------ Title ............ ------------------ .......................... <br /> (if other than owner) <br /> R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --- -- ----•-----•----------•---•------------------ -------------- -----------------•--. DATE ----------- <br /> BUILDINGPERMIT ISSUED ------- - .... .. ........... ----------------------------------------------------------------.--.---.DATE ......... .............. ------------ <br /> ADDITIONALCOMMENTS ------ - - ---- . . ........................................................... ........................ -- -----­..................................... <br /> ---­----------------------_­------- -- --- -----— — —- --- ---------------- ------------------—.......... --------- - -------------------------------------------------------- <br /> ..........­_­----------------- ------- ---- ------ --- - --- ---------- -----------•---- ---------------------------------------_­---------------------------------------------- <br /> ?f <br /> -- --------------------------- ­ -- ------- ---------- -- - ----------------------------------------- ----------------­-------- ------ ......- ---------- ..... <br /> Final Inspection by: ... ... .... .... ------------------------------------I-----------­ ............... <br /> EH 13 21a 1-68 1 <br /> JOAO LOCAL HEWLTH DISTRICT 8/74 3M <br />