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FOR OFFICE USE: � APPLICATION FOR SANITATION PERMIT4 -------------- ----------------------------------------- Permit No: (Complete in Triplicate) _`7`-_�Z_ _________________________________________________________ This Permit Expires 1 Year From Date Issued Date Issued -�9// Application is hereby made to the San Joaquin Local Health District for a permit to construct and install -the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: - a JOB ADDRESS/LOCATION -!! S_ _,- _ 5� -----�$ ---------- AT} .Q ---CENSUS TRACT -.-----rJ--------------- Owner's Name ._7f. _ /�1-----��w-b-z �2 ------------------------- ---Phone -------------------------------•- �'�� Address L. - --------------- ------------ City _/?Or License � ---- --------------------- ........ Contractor's Name ------ �_- �-` -------,- _ Z;3 # _ _ r -- Phone -- -------------------- - Installation will serve: ResidenceApartment House-E] Commercial ❑Trailer Court `,E]Mote ❑ Other -------------------------------------------- �f Number of living units:__------- Number of bedrooms _,-?__-_-Garbage Grinder ---- Lot Size 6V)_C�iYD______________ ___ Water Supply: Public System and name ---ZATH-Ror---- --__________________ -----------Private ❑ Character of soil to a depth of 3 feet: Sand'[-] Silt❑ Clay .❑ Peat❑ Sandy Loam �ay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material- ____ If yes, type ____________________________ 7 (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 seepag permitted if public sewer is available within 200 feet,) Imo.: ��- � PACKAGE TREATMENT [ SEPTIC TANK Size-4'X: _-----X-----------------------_--__- Liquid Depth ___ -------------- Capacity /_�_�----- Type ' 'Mafierial ?�G'/ N Compartments ; _-----/.....:.... Distance to nearest: Well -- �-------------------------Foundation __�_�------------- Prop. Line --- ---.-------___-- LEACHING LINE o. of Lines __iC,----------------- Length of each line_______7�V----------- Total Length -_/..,5 a...._....._- 'DBox ----/----- Type Filter Material ..Depth Filter Material ...... /` __________----------------_______ Distance to nearest:.Well --_- f________ Foundation ....1__6_ ............. ________. Property Line __ __�_____________ i SEEPAGE PIT [ ] Depth -------------------- Diameter ________________ Number _.._______._.___.________9Rock Filled Yes ❑ No i❑ Water Table Depth ,I ---------------------------------------=--------Rock Size -------------------------------- Distance to nearest: Well _________________ _......Foundation -------------------- Prop. Line ............ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -------------- .___________-____) Septic Tank (Specify Requirements) ---------- -------- ------------------------------------------------------------ ?-------------------------_ Disposal Field (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------ --------- --------------- ---- -----=----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin 11 County Ordinances, State Laws, and Rules and Regulations of the. San Joaquin Local health District. Home owner or licen- sed agents signature certifies the following: J "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to beta asub'ect t orkman's C pensati.on laws of California." Signed _ --------------------------- -------------- Owner I BY ---------------- --- - ----------------------------------------------------- Title ---------------------------------------------------------------------- 1 (if other than owner) �- p FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY II' -------- --------------------------- ---------------------------------------- DATE c------------ BUILDINGPERMIT ISSUED -----------------------------------------------------------------------------------------w-------------DATE ------------- --------------------------- ADDITIONALCOMMENTS --------4---------------------------- --- -------------------------------- -------- - ----------------- ------- ----------=-- ----------------------- -------------------------------------------------------------- ------ ------- --------------------------------------- --- --- ----- --- - SAN JO - - - -- ----------------------- ----------------------------------------- --------- ---- ----- - - Finallnspetio Date '_ 4 AQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M