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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT / Permit No. -�.3.-•�....... � _..... �1 ------- �� ' \ (Complete in Triplicate) , This Permit Expires 1 Year From Oate Issued Date Issued ..................../x7 3 .................... •..... - ict for a Application is her made s made n com liaLocal h Co nytrOrdinan a No. 549 and existing Rulesinstall nd Regulations- JOB described. This application +s P X81 E. Ace>apo Fd�.,. Vit- BBCe. .Atl•........ ... ._..CENSUS TRACT ................... JOB ADDRESS/LOBATION -...._. 1%!3 6 -' and Mra. .Ed. �....E3�audet.-- ......' ............. ... ...... ......... ..... ............ -- one Owner's Name 1481 E. ..Aca�po..Ftd, : ..0ampoa.._Ca. . City Aca�np©.... ............ ...... ....... Address ...-----.... ........ a 2617 .� .. Phone .45!T!"99......-- Contractor'sName Np.&Y'"ZieB.-.-.Sept C_T..... &-_.`3 Bower_ r'....License , . .- 3 Installation will serve: Residence Q Apartment House❑ Commercial [:)Trailer Court 0 Motel ❑Other --- Number of living units:_ 1 -__ Number of bedrooms ....3.....Garbage Grinder tot Size 8�p1-e-.•x••240 ©Op�,t1e Water Supply: Public System and name .................................... .... ...... .... ..---.......... .... .- - - ... .........:..........Private ( Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loom ❑ Clay Loam Z Hardpan ❑ Adobe E] 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,) ' ue .. ........... PACKAGE TREATMENT [ ) SEPTIC TANK i ) Size........_-_-_------- - Liquid Depth ... Material, No. dompartments . ..:............... Capacity _.. Type --- .-. _ oQ Distance to nearest: Well _._ ._, ..._. ......Foundation ---- --__- Prop tine . .... Total Length LEACHING LINE :) No. of Lines 1 length of each line .. .Q g rn 'D' Box Yee Type Filter Material .-_r9ak--.-.•Depth Filter Notarial .._ .1- ................... Distance to nearest: Well ....6Q.�_..�:Lgf Foundation a.0:�..:.P1 - Property tine - �, -RI ' Depth25' Diameter 3,p--.--. Number 1 .. .....---.-. ... Rock Filled Yes [� No 0 SEEPAGE PIT [ ) P .._ a Water Table Depth ................... ..Rock Size _Z*...... .................. Distance to nearest: Well ...1 01. .----•- Foundation &IR_1 @ ..... Prop. Line ..8mp1.@....... o REPAIR/ADDITION(Prev. Sanitation Permit# .------ - -. .. .. ....... .... Date _......__.......:... ............ Septic Tank (Specify Requirements) -uirements) . - ----- - . f Requirements) 0-- Q---8AA411 9 4Q.t....0-:r .le"h'...ani..."p" _bay ..aid Qne...... ._. Disposal Field (Specify q ._. . M t e... 1t.... . • .._ ---- 33 _ x. 5_ rock„filled -se.epag.. P ..- (Draw existing and required addition on reverse side) 1 hereby certify that I hove prepared this application and that the work willbe done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or Jicen• sed agents signature certifies the following: le any person in such manner "I certify that in the performance of the work for which this permit is issued, 1 shall not employ as to become subject to Werkm Compensati laws of California: Sign�A# Owner By Title Contractor_. &er) FOR DEPARTMENT USE ONLY_ APPLICATION ACCEPTED B,y ', �rs,�... . .. .. DATE . lQ _ �'.© ? ........... BUILDING PERMIT ISSUED .____. _... - ...DATE ...... .. ............. ADDITIONAL COMMENTS -. --- � ► ........... ... Duce ...................... . . . - Final Inspection by: . _. . .._ .. ...... . ......•----- .... -•--- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT a 7/72 3 X C U 13 24�.�tiA ize�_ 5M- �_ _.