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FOR OFFICE USE: F APPLICATION FOR SANITATION PERMIT �. Permit No. 5;--"o (Complete Its Triplicate) .............. -'........ ............. f - ---•:••--------------------------------------- This Permit Expires 1 Year IFrarn Dat*Issued Date Issued ..�.-�?..1'..?S� I 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 ma a in com Banc with C nt Or ante No. 549 and existing Rules and Regulations: 122 jXG .IOB ADDRESSAOCATION X*.....OAF... �t �,CJ...... ��.................................CENSUS TRACT :..... Owner's Name _..-- � ..... _ ....m- Ne,LTi✓......•---•••.................................................:•...............Phone Address ...............• ;Z f--... _._._../ I�.rP.J!a�f' .--./ ....... .. City ,�. �� Contractor's Name .... !.................License # , ,3'�r�1 X 53 Phone Installation will serve: Residence 0 Apartment House Commercial OTrailer Court �] Motel ❑Other _.. /•%.e....... /��e Number of living units:----�----- Number of bedrooms ----f•----Garbage Grinder ......-..... Lot Size ...Ake ` Water Supply: Public System and name 4 Character of soil to a depth of 3 feet: Sand t] Silt❑ Clay ❑ Peat❑ Sandy Loom ❑ Clay Loam f Hardpan❑ Adobe fl Fill Mpterfal ............ 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 or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE f TREATMENT SEPTIC TANK OLS W [ ] ! � ] Size....:.�i�:._..__....�a_.�.�.........-•--- Liquid Depth .........��,.:_.. J Capacity 95WIType AI'C.": 1 Material No.No. Compartments . Distance.to nearest: Well .__-Foe. ..........Foundation .....�Q�...... Prop. Line .....�.��...-. tA ...._..._1 LEACHING LINE [ No. of Lines . / ..-•--•---•- Length of each hne..._....v�.-.�2............. Total Length ...�'. �.................. . ' 'D' Box .-�1.=..... Type Filter Material .5xXA .e.Depth .Filter Material Distance to nearest: Well ........... Foundation ....e! 49... ........ Property Line -244.............. SEEPAGE PIT ( l Depth ---- ---- ------ Diameter Number ............................ Rock Filled Yes ❑ No I❑ Water Table Depth .....................................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) I hereby certify that I have prepared this application and that the work will be .done 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 not employ any person in such manner ' as to becom ublect tp yorkm n's Co pensation laws f California." Signed . .... ................ .... .. ------- Owner By ---- ............................................ -------------------------------------------------.... title .......... . (if other than ownerl FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------C'-------------- -- ------------• -------- DATE .-Z.'_ - —/7,r { BUILDING PERMIT ISSUED ----------------------- - -- -------------- ------- -- ....DATE ....------ ADDITIONAL COMMENTS --------------�• ....-.-.---- - • :.._..._.._................. t ----•----- ------------•-•-----••-----,--•..........................------------------------•---•--•• -----------------------------.......-------------------------------------------- ----------------- r ......................t. Final Inspection by: -- -------------------- ----- ----- .... ---------.-Date .._:. .__. . � 13 2h 1-68 ReV. 5 .. SA J AQUIN LOCAL HEALTH DISTRICT 8/7h 3M... .......