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FOR OFFICE USE: APPLICATION FOR ' NITATION PERMIT (Comp!to in Triplicate) Permit No. .73-- This Permit Expires f Year From bate Issued Date Issued _J� 17Q Application is hereby made to the San Joaquin Local Health District fora permit t o construct 'and the work herein described, This opplicatio, is made in compliance with County Ordinance No. 549 and existing Rulesinstall Regulat onm. JOB ADDRESS%LOCATION I . ..... �.3:z-_C�) ....-----...CENSUS TRACT Owner's Name W o _ �. _a. .................. ..... ........ OZA fl: ........ .....................Phone -;.fig 7- 35,28' Address ,.._.....:......... ..... :. .•Z ...r'wrtTif / �w�rie so�J sT ........................ -------- •- •------••------- City �� ----- -•................:........•---..... Contractor's Name -, cup/ �'� -•---- --------------------------------------------------- -----...License # - ..--..... - ............. Phone ........ . Installation will serve: Residence Apartment House,0 Commercial ❑Trailer Court ❑ Motel [I Other .... Number of living units:.. ./ Number of bedrooms ..-Z_.Garbage Grinder ..__ Lot Size . _ �-l�e Water Supply: Public Syste i� and name ...._....._�f t � •-- --- -•--.......-----• ---------- - ---- Private j Character of soil to a ---- depth of 3 feet: Sand❑ Silt❑ Clay X Peat❑ Sandy Loam [D Clay Loam [] F Hardpan ❑ Adobe ❑ Fill Material If es ---------------_- _ _ Y type (Plot,plan, showing size of; lot, location of system in relation to�„�e115, buildings, etc; must be pieced on reverse side,) f NEW INSTALLATION; (Noy septic tank or seepage pit permitted if public sewer is available within 200 feet,) I PACKAGE TREATMENT [ ] ' SEPTIC TANK i ) Size-----............... -- Liquid Depth ................ .. Capacity .. _ --.. Type --- •-------- ._ Material------ .............. No, Compartments ..-- -- Distlance to nearest: Well . .... -.__ LEACHING LINE 3 -- ••---------. .Foundation .............. Prop. Line ............. p [ ] No. fof Lines -Length of each line T.,..-.. I ,�....... ...... Total Length 7 i ---.... .. Box Type Filter Material Depth' Filter Material I .... - a Dist ilrece to nearest: Wel! ..-... _. :__.:._. Foundation • _.--...... Property Line SEEP PIT [ 1 Depth .................. Diameter- --------.------ Number -------- --------- Rock Filled Yes ❑ No Water, Table Depth _.......-... --_-_-Rock Size .----- �M' ------ Distance to nearest: Well ..__..----- ---------------------Foundation Prop. Line -------------__.....__ REPAIR/ADDITION(Prev. Sanitation Permit# ------------ ......... --- Date _-- Septic Tank (Specify Requirements) Disposal Field {Specify Reqs uirementsl ..- . 001. ......... Yp (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 Local Health sed agents signature certifies thDistrict. Horne owner or !icon- e following: "I certify that.in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Worktiran's Compensation laws of California." Signed - Owner _. ---_—_ ! other than owrerl .._ Title : FOR EPARTMENT USE ONLY APPLICATION ACCEPTED BY . -- T -�� BUILDING PERMIT ISSUED ...... -_ `T ........... ......... . ..... ....... . ................. DATE ADDITIONAL COMMENTS . ,,... .......... r --- -.-•------ .......DATE - ------------- ....... .....,..---- .....---•. ... ......... . --- . - ..- . --------- ------- ...._....... Final Inspection by: --- .................. .. .. .. . �. .. . - . . - _ .. �_.. - --------------Date SA JOAQUIN LOCAL HEALTH DISTRICT E. H. 13 24 1-'68 Rev. 5M �f 1 _ _ i