SR0084295_SSNL - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE-. APPLICATION FOR SANITATION PERMIT .......................... (Complete in Triplicate) Permit No. Dote Issued ................................... This Permit Expires I Year From Date Issued Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein FAI described, This application is made in compliance with CounVrdjaance a. 549 and existing Pul ,p,oncl Regulations.. IeS6(_'(RACT ........ ........ CE JOB ADDRESS/1-C)CATION, 40 Owner's Name .... Phone ...... ........... . . Address .......... Contractor's Name ..�art> /V AC o" ......... License Phone installation will serve: Residence% Apartment House,17 Commercial oTrai ler Court 0 Motel E]Other _ Number of living units:._- Number of bedrooms ..,-?-......Garbage Grinder Lot Size pl.e�_O'.�:................. Water Supply.. Public System and name ... ... .................. . ....... . ............ ___ _------------------- .-Private Character of soil to a depth of 3 feet: Sand 0 Silt n Clay ❑ Peat 0 Sandy Loom [:] CloyLoom Fi Hardpan 2,"- Adobe 0 Fill Material If yes, type ...... __ ................ (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be,placed on reverse side.) NEW INSTALLATION: ;No septic tank or seepage pit permitted if public sewer is civa�lcible within 200 feet,! I I - / 51 PACKAGE TREATMENT ( I SEPTIC TANK Size.- ............. ., Liquid Depth Capacity 1;2- OP . Type - el_., ;2 Material llh� ..... No. Compartments ........ Distance to nearest: Well .............. ..Foundation ea Prop. Line .9 LEACHING LINE No, of Lines ..... Length of each line Aqo Total Length ........ 'D' BoxType Filter Material lereAepth Filter . 'Material ........... . ..... Distance to nearest: Well foundation Property Line ...... A* SEEPAGE PIT t�' De*pth A Diameter Number...... ................ Rock Filled Yes NO 0 Water Table Depth Rock Size Distance to nearest; Well ......... ....Foundation Prop. Line . ........... REPAIR/ADDITION(Prev. Sanitation Permit # ... --1-1_.___ ........ ....... Date............. ......... Septic Tank (Specify Requirements)) ...... ...... . ............ ............ Disposal Field (Specify Requirements) ............ . . ... .......... . .......... ........... .. . ........................ ........... ................ .......... ....... ....................... . ...... (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done In accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin LocalHealthHo'We—aiiiiiiner or sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person In such manner as to become subject to Workman's Compensation: laws of California." Signed.._. ..... ........ f�"_ ...................... Owner By _._ ............... . ............. .................................. (If er than owner) FOR DEPARTMENT USE ONLY ........... ... ... ......... APPLICATION ACCEPTED BY ... /,ZO5�.a...... ........ ....................... DATE �. W -1 ------------- -- --- BUILDING PERMIT ISSUED ............... ...... ... . ........................ ........... ....... .......... ...... _DATE ...... ADDITIONALCOMMENTS... ................... ___ ....... ........ .................. .............. . ........... -------- -- ............ _______ .................. ..................... ..... .................... .......... ...... ....... ............ ......... .................... .......... ............. .... Final Inspection by.....~ . ..-t ------ _ .--.-.-.-. -_-_--- Hate t —;�p ------- .-Or ---------- SAN JOAQUIN LOCAL'. HEALTH DISTRICT E. H. 9 3 -'68 Rev. 5M