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FOR OFFICE USE: APPLICATIO14 !-OR SANITAT ON PERMIT Permit No. .7,3..�•lb•� ................ ...... (Complete in Triplicate) Date Issued ......................................... ./�'•�•�•7-3 - This Permit Expires 1 Year From Dale Issued Applir,otion is hereby made to the Son Jr,iquin Local Health District for permit to construct and install the work herein and existing Rules rilDed. This application is made in ccmplionce with County Ordinance No. 549 and Regulations, Phone ............................ _ .. JOB ADDRESS/LOCATION ......./.�-. .I./�.......•..>......�..?.I..E_..I.^+..I.,...�-r.CI.I-:-...................CENSUS TRACT i.. . 1..1.7�.�- 1�.:(.1..T .H.E ..... ...............P LL Owner's Name *- — ..................................... ...1.7...3 -7.......... �..........Q'IF l....... G........ ^�A L()Iv . . Phone .............................. W ......... ... .................License # ........................ Contrac, Address or s Name . ... ....................................................... ' ' - '' Ins'ollation will serve: Residence partment House❑ Commercial ❑Trailer Court ❑ Motel ❑Other............................................ / nn nn � �(� Lot Size �l��r.r!.C:�.:........... Number of living units:......7..... Number of bedrooms ............Garbage GrinderA.0 private V Wrt►r Supply: Public System and name ............ Peat Sandy Loam . Clay Loam ❑ a. Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ ❑A� 0. .If a............................ \ l Hardpan ❑ Adobe ❑ Fill Material .lU. Yes,type L \1 must be placed on reverse side.) (Plot plan, showing size of lot, location ion of system in relation to wells, buildings, etc. NEW INSTALLATIOF_': (No septic tank or seepage pit permuted if public sewer is available within 2 0 fe tl'........................ PACKAGE TREATMENT ( ] SEPTIC TANK.[ ] t Size........................................ T e ..... .............. Material...................... U. Compartments ......................' Capacity __.-._....__ _ YP ' Distance to nearest: Well ...... . . ....................•-Foundation ........ ....... ..... Prop. Line ..................... ' Total length ............................ [ J No. of Lines . Le gth of each line .._.... ..... .... . LEACHING LINE ... Depth Filter Ma rial ........................................... D' Box ............ Type Filter Mo eriai .................... Property Line ....................... Distance to nearest: Well ........ . ............. Foundation - P SEEPAGE PIT L ] Gapth .. ........- - Diameter hlumbe _ .i itbck Filled Yes"❑ Nb Water Table Depth ................. ..............................Rock Size ........... .............Prop. Line ................... —{" Foundation ..... Distance to nearest: Well ....... .1.�...................•-••..--• REPAIR/ADDIIION(Ptev. Sanitation Permit# ..- ............. ........... Date ................... .............) Sep'ic Tank (Specify Requirements) ..... ................................................... .... .................... Disposal ,ield (Specify Require ....Il.�*--t..•-••-••-••{ ....... ..... (Draw existing and required addition on reverses I d e I hereby certify that i have prepared this application and that the work will be don` In o.co:danre with San Jeaquln nd Regulations of the San Joaquin Local Health. 01strin. Home owner or licen County Ordinances, State Laws, and Rules a - sed agents signature certifies the following: i arson (n such manner "I certify rh t * the performance of th work r which this permit is issued, 1 shall not emf ev y P as to bacol�,(IAcu b' ct to` 6 a _Co Pe ion laws of California." 1, , ..._ . ... OwnerSi ned ............. ...U. ...t('. .........................g _ .. ...... — 1�' Title _.. ........ . .......... - .......... ............. .. . By �If other than owner) FOR DEPARTMENT USE 7NLY _....._......... ................................... D. ATE..........c. APPLICATION ACCEPTED BY .... ..................... .DATE .. .................l �- •.•.'••-•."/".`.". '.."..1:"...". "..".."...•.." BUILDING PERMIT ISSUED .......... ........... .. ...................... ............................................... . ... ........................._................................. ADDITiONAI. COMMENTS .... . ... .. .................. .._.................... . .... . ..................... ....... ......... • ........ ....... ...... ................................ : Date .... .f........... `�... . fir, Final Inspection bye_ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M