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FOR OFFICE USE: 14,1 APPLICATION FOR SANITATION PERMIT - ----- --- --------� ---•------ --------- Permit No: -�--7�---_--- -��-� '`{Complete in Triplicate) -------------------------------------------- Date issued _ i�This Permit Expires 1 Year From Date issued ------------------------- .: 20 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 es and Regulations. JOB ADDRESS/LOCATION --------------�- - CENSUS TRACT ---___-----_.------_--_. Owner's Name __ Z,_X------ --------------------------------------------- - -----------------Phone ------------------------------------ Address --r/i - G i "`AV---------- 1 f'�� ' 3 tY -------------------------------------------- Contractor's Name AZr_?11 ---- -----------------------------------------License # :-------------- Phone -------- --------------------- Installation will serve: Residence4r Apartment House❑ Commercial ❑Trailer Court ',❑ Motel ❑Other ----------------------------------- -------- Number of living units:-------- Number of bedrooms ---' -__Garbage Grinder --�---- Lot Size - ! ---- ----------------•-- Water Supply: Public System and name ---------------- ------------- ------------------ ------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam;❑ Hardpan ❑ Adobe ❑ 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.) �( 4� NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 feet,) (� A2�" ----------- Liquid Depth f. PACKAGE TREATMENT { ] SEPTIC TANK'[) Size_ `-------------1�------------ �o -_------__ NCompartments �---------------- Capacity A�---- --- Type�-- Material_- .__ o. ompa Distance to nearest: Well -----t --------------------------Foundation -----k$P----------- Prop. Line --- ,.._-------- LEACHING LINE [ No. of Lines _- —---------------- Length of each line--?,?--------------- -- Total Length 1-746--------------- , , I y~ -De Depth Filter Material ---,f�-------------------------------- Y-11 ---- D Box /�--- Type Filter Material - P - ., Distance to nearest: Well A-0'4---------- Foundation _w_--------------- Property Line. f--t.---.-.--•----- r SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ----------------------- --- Rock Filled Yes ❑ No .0 Water Table Depth ------------------------------------------------Rock Size -------------------------------- !, Distance to nearest: Well ----------------------------------------Foundation -- ----------------- Prop. Line -------------_-... REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------- ----- Date ----------------------.-----------) 53 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 Sass Joaquin 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: "I certify that in t performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to be t to Work an's C ripen tion laws of California." Signe -x--- - --------- -------------- -----------r I- ---------------------------------- Owner By -- ---- --------------- --------------------------------- --------------------------- -------- Title ---- ---- -------------------------------------- ----------------------- - - (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .- �----- DATES `* BUILDING PERMIT ISSUED ---------------------------- ----------------------- -------DATE ------------------------------------------- ADDITIONALCOMMENTS ----------------------- --------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------- --- ------------------- ------------------------------------------------------------------------------------------ ---------- ------------------=---------------------------- ---------------------------------------------------------------------------- --- ------- ------ Final Inspection by: - - _ --_------Date P� '- ---- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev, 5M