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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ................,:,c— - Permit No. 73_ S (Complete In Triplicate) - - .......- -.....rr..-- ..........:'-.- ....-� 3c,73 � _ Date Issued -- 3�-..---..... .-------------,-,•-.-,-„------_... This-Peimif Expires.1 Year From Date Issued Application is hereby 4fnade o the-San_Joaquin Lcal Health District for a permit tb construct and install the work herein described. This:app`icbi%i Mis-made In compliance with County OPdinance-No. 549 and existing Rules-and-Regulations: JOB ADDRESS/LOC-ATION ._--AD-1-zNNr_.bi�_-CENSUS TRACT ..5--- 1..41. ---- Owner's Name , 10WI1..F ....--�--- .1504ELAA-----------•----......-p.. ...........-.... .Phone..._�.....--------.j........... Address 5�' ._. -A L),$ �Z-1�l-: R D` - City ./Cl--l:..�.�. '....---�c3�i ....-.. - Contractor's Na�e iF{.PS.._.. /}S�5 ----.� A ��-.License # ------ - Phtonei ------------ --------------- Installation will serve: Residence ❑Apartment House❑ Cov rcial:❑Trailer Court ❑ �! i, Motel ❑Other ............................................ Number of living nits':_. ..... Number ofnble�dro ms ��,b...Garbage_Griinnder�_� Lot Size ...� a_ta_----------- Water Supply: Public Syster> and name . P�3 en�G-.s, EE S;i...FE51- TF. .---....-!- ---.-...Privdte ❑ 1 r r { Character of soil to a depfh o44eet: Sand f Silt❑ lay [] Peat❑ Sgndy Loam ❑. Clay Loam [ � 1 Hardpan,❑ 7kdobe'❑ Fill Mriterial V�-'- If yes,type.--....-t�-._--.__--.._-i L (Plot plan, showing sizer oi1oti location ofd system in relation to wells, buildings, etc. must be placed on tev rse side.) L v NEW INSTALLATION: (No septic tank or see ge pit permu�tred if public sewer is available withI 00 feet,) i i• 3X9�xs d-5x10x PACKAGE TREATMENT [ ], SEPTIC TANK./it? Sae.... ..-_---------------------------------_ Liquid D pth .-:..-7LL___.-_.;........ It /Z1 Capad4y-1 . Q .fTy �F��`��/Material-.e0fd it No.t CompaPtments; _._ .---- o (' t.. / 't.. Pro stanc • T neares4: Well .......... .:......... ..Founda/tiioon ...!/ ....----..-. p. Line ---- .---..- - r LEACHING LINE [/J/No. of Linea „.----._.._- Length of each line7�_s-.`-60+6.Q Total Length --��t Jr.---..- 'D' B zJ�� r I // /� t. er,7- Type Filter Material .,F�fl..�f.S-Depth Filter Material -....-/..9----------------- Distance to 7tearest Nell ___ e.W....... Foundation7+�- 1� {Q'!PFoperty Line ��................. SEEPAGE PIT [ ] DepthA....._�-_--��.�iameteri............... Number _.__-_-_-----------'...___-_ Rock Filled Yes'❑ No ❑ % Water Table Depth)!.! t .............................Rock Size .....i------.......E--........ f 1 1. Pro Distance tomeorest:-Well .---.___� ....................... Foundation :--------.-- p. Line,. .-...---...-----..--.. REPAIR/ADDITION(Prev. Sanitation Permit# --------------------- ------------------ Date -.--- E ++ .............. .r.-........--.-.._,. -:--------............... � r Disposal Field' (Spec Requirements) -------------•------------=....................- ........ 1........... ... .............. -......-----............ _- ._ ^ -------------------------- -1------------------...-.-----------I-.....---........ - --...... ---------------- ----....... . .................. - - -- - ---.-'' ------------------------ (DraNN,existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordonpeiWith 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 t a in the pe o4the .Far which this permit is issued, I shall not employ any person in such manner as to be subleet to kat n laws of California.” Signed -- - -- -- -------- -- -- --4 i............-1----.t--.-.. Owner { By - - - - Title t... --------------------------+ . ...............--... (If other than owner) r` FOR' DEPARTM€NT USE ONLY I APPLICATION ACCEPTED BY - --.1- ,.0.. - •.------------ --- ...... DATE�..:_� ' - BUILDING PERMIT ISSUED ....... . ------ ---- -fir -- - -( ........ ..............DATE . ADDITIONAL COMMENTS -------- -....1 . �_...__ ) --------------- - - !_ •. -- ------I---.......--- - I /. . - ------- ------- ............... Final Inspectio T; --------� - - ................Date ---- ,.. JOAQUIN H EAL-Ti'I'6ISTRICT E. H. 9 1268 Rev. 5M