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FOR OFFICE USE: APPLICATION, FOR SANITATION' PERMIT ."..... ._ .... .......... _.-... - ...... ._�. Permit No. .:.�s.`rU/ tCamplete in Triplicate) P This Permit Expires 1 Year From Date Issued Date Issued .�.-,�1�..-..7..�.. __...... .......... 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 made in compliance with County Ordinance No. 549 and existing Rules and Regulations: /3/5� . l ..CENSUS TRACT ..........................JOB ADDRESS/LOCATION . ._A . aS Owner's Name .......5774-F,�,E.. ........................................:.........................Phone 0�3... 11.5.. ...... Address /3..J - ----.-----_- ------•city .......................................... Contractor's Name .. A..L... uL.>/G-'/ -. - License #5?7510 .. Phone Installation will serve: Residence ) Apartment House�❑ Commercial ❑Trailer Court 0 Motel Other ----_--------_---- Number _--------- -Number of living units:_ _.�__ Numberb efdomEl.... .. r .. .. ... Lot Size . ........................ Water Supply: Public System and name'"' = :ti_� �. i. ,.`-.. Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam V Clay Loam ❑ Hardpan ❑ Adobe ❑ 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 wer is available within 200 feet,) // PACKAGE TREATMENT [ ] SEPTIC TANK t ] Size...J`^X.�7 -•1�1. �_..._.....-_ --- liquid Depth ....4 ............... Capacity A*-U _ TypePR&ti.Z77—Materiol_-- _ .-.. No. Compartments -.., .............N / r e Distance to nearest: Well 7� .. ................Foundation �D...... Prop. Line ..12-1........... LEACHING LINE ( ] No. of Lines f"L""f WpLength of each line / X 4 Total Length/ ........ ..............� 'D' Box . / Type Filter Material ✓Ao KPADepth Filter Material ..../V/.............. ...•....---.---. Distance to nearest: Well .. --. ---------_.... Foundation Property line --......................Vs SEEPAGE PIT [ J Depth _-. Diameter ............... Number Rock Filled Yes [3 No I[] Water Table Depth -- ................................Rock Site*.....- -•---• ----------- 17 Distance to nearest: Well .._. .................................Foundation -.- -- Mm._,,.- 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 Locat Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this pertnit,�s i{s ,�,sh61)'ngt " any person In such manner as to become subjectrt7- By -- an's Compensation laws of California. . i f' Signed . _ i :_ ... ..-._.. ................ Owner Title (If other than:owner) C _.,., FOR DEPARTMENT USE'ONLY0- APPLICATION ACCEPTED BY `; . : I?ATE . .p�-" .... .. . . .... .._- BUILDING PERMIT ISSUED,._ __ _ -SATE . . ....... .............. ADDITIONAL COMMENTS . . _..:-- -------- ------ ........... .......... ... ............ ...... ... .. .. 'i('` -. .. .. ...Date .. .. !-) .._I. .............: Final Inspection by: .. .- - ---------- ----------- .............. ------- -•---- - •-------._. . .. ..:.: . . t�` SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 13 241-'68 Rev. 5M 7/72 3 A