Laserfiche WebLink
FOR OFFICE USE: <br /> :I.. <br /> APPLICATLONO�P_011t SANITATION PERMIT <br /> ---------- --------------------- <br /> -------- ----:--. Peimit No4 <br /> I in Triplicate) ------------- <br /> ----- ---------------------------------------- <br /> V <br /> - <br /> --- ------------------------------ ------------------ This Permit Expires I Year From Date Issued <br /> Application is her0��b� made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This applicdtion is made in I' nce ith Count Ordinance No. 549 and existing Rules and Regulations! <br /> JOB ADDRESS/LOC' ATION ---------------------------------- ----------------------I------------------------------- -------i------CENSUS TRACT -----5'- <br /> 7 <br /> -34 qc <br /> Owne'r's Name <br /> -A -------- Phon <br /> ----------------------------------------- -----------------.- e ----------------------- <br /> Address 44 7214049 1A �r- <br /> ------------------------------------?1- -1------------------------------------------rCitYS44 - - --------j---G------------I/---- .............. <br /> Contractor's Name ---------------- -3-0 <br /> ------------------------------•----------License - ------- Phonee9_Z_-M'_0_-S._:5 <br /> Residence []i d ence [!9 A pa rtm ent House se <br /> Installation wit[ serve Commercial []Trailer Court <br /> Motel,F-1 Other -------------------------------------------- <br /> qjNumber of living units.-I------ Number of bedrooms -_.______Garbage Grinder ----- Lot Size -------------------------------- <br /> Water Supply: P661 ic System and name --------- 0 <br /> ---f----------------------------------------------------------- ---------------------------------------Private <br /> Character,of soi I'to a depth-of 3-feet:._Sand' <br /> P &lt C] -Clay E] -Peat-[], Sancly Loam­24,�Clay Loam,�[D- <br /> Hardpan E] Adobe'Ej Fill Material ------------ If yes, type ____________________________ <br /> [Plot plan, ib <br /> i <br /> t <br /> l <br /> t <br /> showing size of lo , location of system n relatn to wells, buildings, etc. must be placed on reverse <br /> f side.) <br /> NEW INSTALLATION: {No septic tank or seepage pit permitted,iLiublic sewer is available within 200 feet,) <br /> 9 ......... <br /> PACKAGE TREATMENT [ ] SEPTIC TANK Size- A—---------- --X-40----- L quid Depth _401�P <br /> Capacity4200------ Type W--- Material 6 No. Compartments ............... <br /> - <br /> 41 \-Foundation Z-0- ne u5'_'o------------ <br /> Distance to nearest. Well ___6 Q-- --------------------- ------------ Prop. Line _..._.:__...___ <br /> LEACHING LINE No. of Lines _____/________________ Length of each line./jPV......... Total Length 1-419---------------- <br /> 'D' Box A-4___ Type Filter Material VCA! -----Depth,,Filter Material A?------------n----------------- ------ <br /> `-t e - <br /> Distance to nearest: Well --- ---------- Foundation Property Line <br /> PIT Depth -------- ----------- Diameter ---------------- Number ------------t------Yr__'___- Rock filled Yes ❑ <br /> No ❑ <br /> Water Table Depth ----------------------------------- ------------Rock Size!------------------------------------ <br /> Distance to nearest: Well ------ ---------------------------------Foundation -------------------- <br /> Prop. Line ---------------------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ------ ---------------------- <br /> Septic Tanl� (Specify Requirements) ---- ------------------------------------------------------------------------ <br /> kt <br /> -------------------------------I--------------------------- <br /> Disposal Field (Specify Requirements) ------------------------------------------------ ;:__!------------------------------------------------ - -- <br /> I -I 174i i- <br /> ---------------------- ----1 -- -------------- m-------------------------------------------------- <br /> ----------------------------- -----------------------------:----------------------------------------------- -------------------- --------------1--------:--------------------- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify thatj I have prepared this application and that the work will be done in accordance with Son Joaquin <br /> County OrdinLrile's,;State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: I <br /> "I certify thatAnNhe performance of the work for which this permit is issued, I shall no�temploy any person in such manner <br /> as to becomelsub'iect to Workman's Compensation laws of California." <br /> Signed - Owner <br /> A <br /> -------r --------------------------------------------- <br /> ----------------- <br /> - ---------- <br /> By ------16-, . . , --R�� ------ Title 04 I.-T-74 <br /> (Ifio ther than owner) *�i I <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----- 7 7_�__JR_4?------------ ------------------------------ DATE --- <br /> - _71- ---------------- <br /> BUILDING PE)RAAlt ISSUED ---------------- - ------ ------ ----------- ------DATE --------- --------ADDITIONAL]COMINENTS- -ff:' 0 1 <br /> MW --- ------- <br /> ---- ---- - - ---- ------ ------ ----- <br /> -------------------- <br /> - _..�.,Ar------- - --- ----- -- -- -- _7`-`---- ----------- <br /> -1 b <br /> - - <br /> ----------- <br /> - <br /> -------------------------------------- ---------- - --- ----------------- -- <br /> 1i --------------------------- ----------------------------------------------------- <br /> ------------------------------------ ---- -- --- - --r�_ 1*-------- -------------------------------------------- ------ <br /> --------------------------.-Date ...... <br /> Final In --------- <br /> SAN JOAQUIN LOCAL Hg-ALTH DISTRICT\ ,' <br /> �. 9 �1 i'-'68 Rev. 5M <br />