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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT .....................,, .AV-.._......... Permit No.j ... (Complete in Triplicate) 4 Date Issued 5..._...6"=fir " ...................................................... This Permit Expires 1 Year From bate Issued Application is hereby made to the San Joaquin local Wealth District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 544 and existing Rules and Regulations. / CENSUS TRACT .......................... JOB ADDRE5S/LOCAT ON .. ...� -�.l .. ......._ � �---- ------•---- ----- ._ ..�-� --- ------ Owner's Name .........lr�....__... .. . ............. --- --....Phone .................... .. Address . . ...... ............................. ............... -------------- -•------- ....... City ----...----.--- ........... ........................................ Contractor's Name icense # f - Phone . r.�. Installation will serve: Residence ❑Apartment Nouse F] Commercial OTrailer Court MotelA Other . . Number of living units...o2-r-Number of A-1- ooms a..2—Garbage Grinder ._. Lot Size _.-'L-._.�.Z. - • _..._Private Water Supply: Public System and name ...... r ..1j`` ❑ .. Character of soil to a depth of 3 feet: Sand Silt❑ Cloy ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe X Fill Material .._.......- If yes,type ...---------------------- - (Plot plan, showing size of lot, rocation of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE: TREATMENT [ SEPTIC TANK I IE ize. ----_-----._......- ................... Liquid Depth ......................... : P AJJ f,lU G; J 1/ 7–fi pacity Q'. A � Type J0 Material.... No. Compartments - ....... ........ Distance to nearest: Well �a...__.._...............Foundaption .../.._.. .......__ Prop. Line .- -. ...- -. LEACHING LINE i No. of Lines . 1 _ . Length of each [Vine ._...._/.. ---- Total Length ....9Q•f.-_-....-..• i 'D' Box --Ig—. Type Filter Material ---AQ- ___Depth Filter Material ...f. .�..........................-_-. 11 Distance to nearest: Well ..W--------------- Foundation �a ...._..._.. Property Line -.1 ------•....-..---- SEEPAGE PIT �° Depth ..__... Diameter �j ___._.._ Number . ......�. .............. Rock Filled Yes , No 0 ` Water Table Depth ...... ---------------------------Rock Size ••----- , Distance to nearest: Well ../. ...r......................Foundation ---/.--Q . --.. Prop. Line _ .._..------ ( _L -_ Date __. I REPAIR/ADDITION(Prev. Sanitation Permit�# .___ZS. ��7`.�..-. L---------------- l.-7p.945--&...... � Septic 'Tank (specify Requirements) - .. . . -•................. Disposal Field (Sp cify Requir ts) . - r .. . • . . . ........... -.....--- ... _...... ..c4� -- .. ... ..... . ............ ................ w existing and re red addition on reverse side) I hereby certify that I have prepared this application and that the work will be delve in accordance with San 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 the performance of the work for which this permit is issued, I shall net employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed . . - _- -------------------- ---------------- Owner By - Title ................ (lf other than owner FOR DEPARTMENT USE ONLY , APPLICATION ACCEPTED BY . .. . .._. . DATE .. ...... .. BUILDING PERMIT ISSUED ......... ..... _ DATE ADDITIONALCOMMENTS ......-- -------- - -------------- ----•-•---------------........... ........_.. ................._....--------.----------I......................... . �e–1 _. -..------------ -- - • --....-----------....._...-- -------------------- -_..---..... •----- . -------. --.. . .. . -- ------ ---- . .----- - ._....._..-- -- -. Date Inspection by: ....... ..... ...- ------ -- ---- - ------ • �__. .. ' SAN JO QUIN LOC L HEALTH DISTRICT 7/72 3 IK H 1.3 241-'68 Rev. 5M __ _