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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> - � 11 �:* Permit No: 6 <br /> --------------------- (Completp in Triplicate)' <br /> ------ ----ZZI-24--- Date lssuecls_�_zf::143 <br /> This Permit Expires 1 Year 6om Date Issued <br /> SfA <br /> ------- - -- <br /> Application is mer M"40de to the San Joaquin Local Health Di'strict 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 /> 17 <br /> JOB ADDRESS/LO TION..__=-<_1S A;?$----------� VAO -------- ---CENSUS TRACT -------------- <br /> Owner's Name 5-7v P_,e ZAI--------------------------------------- ----------*­-------------------Phone------------------------------- <br /> -------------------- City -------------------------------------- <br /> Address ----Azpw_ <br /> -, X___ - ------ - <br /> Contractor's Name _,.5��_.License #,Z_5_-fC1Z3_ Phone <br /> Installation will serve: Kesidence)KApartment House,[] Commercial E]Traile:r Court C] <br /> Motel E]Other -------- -- ------------------------------- <br /> Number of living units----- ----- Number of bedrooms -- ------Garba'ge Grinder ------------ Lot Size ------------- <br /> Water Supply: Public System and name --------- -----------------------------------w----------------------------------_------------Private El <br /> Character of soil to a depth of 3 feet: Sand 0 Silt[j Clay El Peat E] Sandy Loam -E] Clay Loam E] <br /> Hardpan ❑ Adobe K' Fill Material ------------ 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 tank or seepage pit permitted if public sewer is available within 200 feet,} e, <br /> PACKAGE TREATMENT SEPTIC TANK'[ Size-----_—:5— --------- Liquid Depth --------- <br /> Capacity -lo?.00----- -TypeMaterial Compartments --------------------- <br /> "'w'_ 77 V- <br /> Distance to nearest: Well ------11*/16 ---------Foundation __,40---------- Prop.' Line - ------------ <br /> es --- -4----------------- Length of each line3-S-.fT io��ord'Total Length ,_-_J-2 jQ__------- <br /> LEACHIING LINE N o, of Lines /_ ­ - -.;ol- ___7_ IV, <br /> /23' k----Depth Filter Material -------11!W------w-----------_---------- <br /> `D' Box (_,,`P'7e-k2?&Type Filter Material el <br /> Distance to nearest: Well --- Foundation ----IAP-------------- Property Line --Iy---------------- <br /> SEEPAGE PIT Depth --- Diameter __13 --- Number --------e,--' c._-----:_-- Rock Filled yes ''E- No 0 <br /> Water Table Depth ----------- <br /> -------------------------Rock Size --e?7�---- <br /> r ---- <br /> - - <br /> Distance to nearest. Well --___---__,____Foundation ._/�---------- Prop. Line ....74i........ <br /> REPAIR/ADDITION(Prev. Sanitation Perrnit# -------------------------------------------- Date -----------------------•----------1 <br /> -------------------------- <br /> -"Septic Tank (Specify Requirements) _____ <br /> DisposalField (Specify Requirements) -------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------- ------------------------------- ----•-----t------ ----------------- <br /> - ------- -------------------------------------------------------------------------------- <br /> ----------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------- -------------------- <br /> (Draw existing and required addition on reverse side) - <br /> t 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 /> se,d agents signature certifies the following.- <br /> ha the person in such manner <br /> I certify C" h performance of the work for which this permit is issued, I shall not employ any <br /> a performance <br /> as to beco e ubje�. rkman s (rompenscition laws of California." <br /> ISigned ----- ----------------- - -------------- - -- --------------- -'Ale------------ Owner <br /> iifBy ------------------(If__other-- - /than o---ner) ------------ Title ---------- --------------------------------------------------- <br /> FOVIDEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - --------_ -- - -------------------------- DAT --- <br /> --------------------------------------- <br /> BUILDING PERMIT ISSUED ---------------------------------- ------------------------------ --------------DATE <br /> ADDITIONAL COMMENTS ------------------- ---------------------- - --- --- <br /> ------------------------------------ --------q_- ------- <br /> --------------------------------- -- ------ -------d`��------------------------------------------------------------------------ - <br /> ---------------------------------- <br /> ----------------------------------------------- -- ------- -- ---- <br /> - ----- ------------- -------- e --- -- ----- <br /> ------------ ------Dot <br /> - ------- ----- --- <br /> Final Inspection-by:------- <br /> -SAN JOAQ LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M. <br />