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FOR'OFFICI'USE: c� A.ICATION FOR SANITATION PERMI` F ---------��-- Permit (Complete in Triplicate) ----------I------------------------ ----------------- ,:r- Date Issued -------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin'local th District for a permit to construct and install the work herein described. This application is made in compliance wit County Ordinance/No. 549 and existing Rules f nd Regulations: JOB ADDRESS/LOCATION ------ AmJ AFF _- CENSUS TRACT -----------------------••- Owner's Name • ------------------------------------------Phone �.0!!L– ,3� ` cl�f�isi4-= , - Address ---- City ----- ------- License ----------.License # r _/7? Phan _ Contractor's Name _._ -� t,�'rF ---�- - Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court l Motel ❑Other -------------------------------------------- Number of living units_____________ Number of Bedrooms ------------Garbage Grinder ------------ Lot Size --__________.___--__.__-______________-_-- Water Supply: Public System and name ------------------------------- -••---------------------------------------------------------- ------------------PrivatK Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam ❑ Hardpan ❑ AdobeK 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 septic tank or seepage pit permitted if public sewer is available within 200 feet,),%" PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size------------------------------------------------ Liquid Depth ---r:.______..------------ r,,� Capacity -------------------- TYPe -------------------- Material--------------- ------ No. Compartments ---------•---•---•---- La Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line --------------.------ LEACHING LINE [ ) No. of Lines ------------------------ Length of.each,.I' e -------------------- ------ Total Length ----------------------------- Depth ----:----.------._-------- p D' Box _____-._____ T "Filter Material Depth Filter Material __________________!r_______..______..-_._ _ �� r 6C Distance t�o nearest: Well ---v-- ---+------1--- Fouridafi on ------------------�.---,PProperty Line------------------•----- ,�; _� - Ac SEEPAGE PIT [ ] Depth ,d4 ___'__ -- Diameter. '_____ Nuriber F--------�"-- � �o�Filed Yes Na i❑ �{ - \` Water Tab(e.Depth �" --`---- -------------- ---Rock Size _ K--�-- --------: f5 ,� �1��**---l Distance to nearest: ell ____ sSd__ __ __________________Foundation __ -�-_ ____ Prop. Line'---C REPAIR/ADDITION{Prev. Sanitation Permit# ,_ ----- -----------,- Date -_____________ I � I _ _ _ Septic Tank (Specify Requirements[1 .:..#-------- ------------------------ = f � ' ` _ ----------------- t ._.- ; tDis Disposal Field {S ecif Require ------e �. oil ------------------------ ----------- ---------- _ _. (Drw,existing andYrequired addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Law and'Rules-on0 Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: *, tp "I certify That i he performance of the work for which this permit is issued, I shall not employ any person in such manner as to becom s lect to Workmpn's Co nsation laws of California. Signed ------ ----- �3'` -: Owner -+- c -� Title of anro;ne ) I.� f ` ri 1 O ARTMENT USE ONLY I } - -------- --------------- Y----------- APPLICATION ACCEPTED-BY---__-�-� -'---' - --,�L. -- --_----. DATE _.__�_I�--�- - BUILDING PERMIT ISSUED - --- --- .----- ---------------------------------------------------------DATE ADDITIONAL COMME T ------ - ---- ------------- --------- --------------------------- ---------- --- - - _ ------------------------------- - ------------- ------ ------ - - ----------- - - -- - --- ------------ Final Inspection by: - ------- ------------------------------ S -------------------- -----• Date '. /S�=w S JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Re . 5M