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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT `7 Permit No........---`t.tP-�.. (Complete in Triplicate) Date Issued.$. 3/-7-9 ---------------------- .............. ........... ..... This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. k Ordinance No, 5a9 and existing Rules and RegThis application is made incompliance with County Mations: JOB ADDRESS/LOCATION.._..... '- —-------- .�f- 1 �+'� ------ .CENSUS TRACT t Owner's NamesAZOSV...... ............. ...........:..... .... 1 Cit ....Zip-- = ------- ------ i Address. T V�� # Phone.-IF Contractors Name._. . ........... -.a . Installation will serve: Residence', Apartment House [ICommercial ❑ Trailer Court ❑ t Motel ❑ Other----------------- Number of living units:---. .._.......Number of bedrooms. -_--.-.Garbage Grinder---------...Lot Size._.. ..... ...... Private Water Supply: Public System and name..._ .... ............ ... .... . ----- :.. •----- •........... :... - Character of�soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat [I Sandy Loam 0 Clay Loam Hardpan ❑ Adobe F] 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 septics tank or, seepage pit permitted if�ublic sewer is available within 200 #eet,] , y, i [ ', Size..- _..�C9�.�r.. _Liquid Liquid Depth.. ---- ----K�_ PACKAGE TREATMENT [ ] SEPTIC TANK.[ ] i�,� _ 1 `_ _...T e_ -.CASlMoterial -------------No. Compartments---...:�. .. Capacity. - --- Type- = - i f Foundation. . -- ----- Distance to!neare_st::Well----6'�- . - -------- _Prop. Line-.-......--- l LINE [ ] No. of Lines .__. --------------Length# eac Kline .. Total Len th _. - - _ ........ LEACHING � - .. ---. .. --- !l ?(V Depth Filter Material........- ........----- �-� 'D' Box-._�......7ype Filter Matenal�-��-- � ,,,,vv��, l� .....Foundation c4..-•------.......---Property Line....�1 �-- ............. Distance to nearest: Well--I� ..--. - i SEEPAGE PIT;. [: ] Deptlt......__ -.w_D,iameter--------------- ----Number-.----------�-�--------- ----------------- ------•------- Rock Filled Yes ❑ _No ..--••--.Rock Size.. .....................-------•-------------- F Water Table Dept.h------:--•---------- -- Distance to nearest:`Well--------- -------- ------ Foundation r_.Prop. Line. r A - ] REPAIR/ADDITION (Prev. Sanitation Permit#_------------------ ------ ------- -- --------...Dote - ------ ------ ------- . 1 if , If Septic Tank (Specify Requirements)-..._;..r "- ------------------ --------- ---------- - Disposal Field (Specify Requirementsl-°--- K....... 1 ( ----- ------- ------- ------- ....... ................ „ ;; f ---------- k i I �� , 6 ................ . I (Draw existing and required addition an reverse side + I hereby certify ,that I have preparba this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Ru'les and Regulations of the San Joaquin Local Health District, Home owner or licensed agents signature certifies the following: I certify that in the performance of tfjg work,�for which this permit is issued, I shall not employ any person in such manner as " to become subject t Wa kman's Compensation laws of California." Signed------ '- ---- ..... ....Owner k ' (lf Title.._..By - other�than owner) p FOR DEPARTMENT USE ONLY 01 DATE -"--: APPLICATION ACCEPTED BY_.... .... .� .. _._._ _ _ . .- :�: ---.DATE_ _ - ... _.. DIVISION OF LAND NUMBER':-.." . ......... .... -- . --------- ------- � ADDITIONAL COMMENTS.- ------ - ------ --- ---------- --------- ------------------- --- _.. _... .G � Date...-.. C� Final Inspection b � f&S 21677 REV. 7/76 1 EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT