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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �� Y� Permit No. .1 3- 7/S (Complefe in Triplicate) �... . ......... /.zsJ 3 7 Date Issued .. a.:.73. .................... ,,-• T�hL Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This apph ti n i r� !Zp�llince with Cou ty rdinance No. 549 and existing Rules and Regulations:OB ADDRESS/LOCATION ........ .1� tt... �`�� ..` .��..•........... ... ............CENSUS TRACT........ Owner's Name Ilei V......./�_t�i_.'A................................................ ..........................Phone ....`r .1�o ... Address ._....��.� ....._/ /I!.L? .�itl... 1.!j......--•--•-•................ City . ............................................. ..S.Td!..t"TU 7 S ... PhoneG..�..;/ Contractor's Name ............................................license #pct... .. .. Installation will serve: Residence ❑Apartment House 0 Commercial QTroiler Court 0 r,4 R>v! 44 15.04 Motel ❑Other .--•--. -•------........................ . ._ Number of living units:...- ... Number of bedrooms ... ....Garbs a Grinder ............ Lot Size ..l-l��£1....f�. :. _•-••- Water Supply: Public System and name ..........................................•. ......--.......---.._.........--------..----.-•---............Private Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat Q Sandy Loom 0 Qoy Loam ❑ Hardpan❑ Adobe j) Fill Material ....... .... If yes,type .... ....................... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be pasted on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANK 5iae..F �, .1!�/Q-•--1�--•-�E°......••.... Liquid'Depth .. Bss - \ Capacity Type _48R97<45s Materiol.a=2 ... No. Compartments ....Q.............. Distance to nearest: Well ......./.(f7i°_I................Foundation ......... Prop. Line ...................... Tl LEACHING LINE No. of Lines .. - •-.•-.- Length of each line..-.. Length ... ti 'D' Box --.. Type Filter Material Depth Filter Material ..f%.................................. .fes iso >l Distance to nearest: Well ............... Foundation ........................ Property Line ... ..._.... SEEPAGE PIT [ ) Depth .................... Diameter ................ Number ............................ Rork Filled Yes Q No t3 Water Table Depth ................................................Rock Size ................................ y�y Distance to nearest: Well ..............................:.........Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit#r ............................................. Date ..................................) Septic Tank (Specify Requirements) ---... ...........--•..............................••-•--•---............ ......._....._.........................._...............-- Disposal Field (Specify Requirements): .......................................................i.............................. .............................................. ..........................:................................................................................._---......................................................................................... (Draw existing and required addition on everse si e) 1 hereby certify that I have prepared this application and that the work be one in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the Son *Win Local Health District. Mom* owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is iss e& i shall not employ any person in such manner, as to become sub)e t t orkman's Compensation laws of Califgrnia." ® ............ Owner Signed ----• .. G� ...................................... ---• Title ..... (If other than owner) .t OR; EPA NT USE ONLY, APPLICATION ACCEPTED BY .. ../.. S DATE .... .._- `f.. ................ BUILDING PERMIT ISSUED .......... ............... ...............................DATE .................................. ADDITIONALCOMMENTS ................... ..:......_..................................................................•----.......... ................................................................................................. ..X ._................................._......_...._........._............_...._..._ .. ....................................................................._ ... ... ............................................. . ............................ : ......t. ... . .... .... ................. ' Date Inspection by: ... . i SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.13 241.'68 Rev. 5M 7/72 3 M