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FOR OFFICE USI:: �, � APPLICATION! FOR-eANITA` TON PERMIT 73. 3ii .............\� Permit No. ..__..........__..... ............................... (Complete in Triplicate) Date Issued ._....-_...:�.... j This Permit Expires 'I Year From bate Issued _ *; _ Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install-.t*,work herein described. This application is made;in compliance with County Ordincdnce No. 549 and existing Rules and Regulations:' . CEN5U5 TRACT .... ---•> JOB ADDRESS/LOCATION ........_... _ ..� I . ._-� 7.c.... . � /�.. .�- �-•�..--••--........ ..............Phone ........ •-•---••-•--. Owner's � Address ......................................•---••-------••--• 10 Contractor's Name ...... License #!x•,11-. 9Phone f .•.. - Installation will serve: Residence [ Apartment House 0 Commercial❑Troller Court '❑ MotelOther-------------------------------------------- Number of living units;....f:.___ Number of bedrooms .._Z.._:.Garbage Grinder ./� 1� La# Size + ,_ kva Water Supply: Public System and name------ ...... Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Pe.at❑p1/SondY Loan"' ❑ Cloy Loam ❑ Hardpan ❑ Adobe Fill Material ............ If yes,type 4 - (Plot plan, showing size of lot, location.:of:system in relation towells, 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,) ... Liquid Depth PACKAGE TREATMENT.i[ ] SEPTIC TANK t,�^T Size....-----•--......... ..._. q ................... ICapacity � ..... Material--------�------ ------- No. Compartments ..............:...... - -�Foundcrtian — Prop. Line t Distance to nearest: Well --'-`�-••"---��•�••• oQ t Length of eachIline-------•--------•.. Total Length ...............I... .._. s LEACHING LINE [ ] ;No. of Lines ------------------••, 9 ;. ------ ............................... i; 'D' Box _..._.._._ Type F;Iter Material ...................Depth Filter Material - Foundation ....---................. Peoperty Lits......:+•---••-• Distance To•nearest: Well ................ . � SEEPAGE PIT [ j Depth � - •Diameter ____.... ....... Number 3.:....................••.. Rock Filled Yes ❑ Nlo � 0 Water T`able Depth Rock Size ................................ Distan4e-to nearest: Well Foundation ...........:........ Prop. Line ---....--------•---... ............... —_ y i REPAIR/ADDITION(Prev. Sanitation Permit# ------- ......... Date --.---------•-••--••..............) i ....._..... . - -•--•--•---- Septic Tank (Specify Requirements) y------ "�- .1 _ Disposal Fi {Specify, Requirem t .._ I / -----•-•----•----------- ---•----•---•-•--•------ -------------------------------------------- --.......... -------- ---------•-- ;... - . -...._.. ...................................... (Draw existing and required addition on reverse side) II I hereby certify that I ha prepared this application and that the work will be done in accordance with Son Joaquin _ Countyl0rdinances, State Laws, arsd Rues and'Regulations of the San Joaquin Local Health District. Home owner or I,icen- sed agents signatorcertifies the following : "I certify that in`the performance of�the�4ork for which this permit is issued, 1 shall not employ any person in such manner i as to become subject to Workman's dam en:atia laws of California." � i. Signed -_ .........___..... _..._.F . r ..-- ................ !...........4. ................... ...... .......:.. . Title . h r,fho o nerj j FOR DEPARTMENT USE,,ONLY APPLICATI ACCEPTED",ZY ... DATE 3 _...... BUILDING PERMIT ISSUED ................. :........... .......... OA E _ - - — ................... ADDITIONAL COMMENTS..` •. :...........R.. :..:_........._•...,......---•....._----•----...------......_......_..--............. .........._:. .,_ .... ............I------------ -----..........i. ....... .4.- -'--- .............._...____.._......_._...._.__........__.........._ --. ....-... - _._ ------- .........._. ................... Data ......_ _.-D.... ..... Final Inspection by: -•--••................... .�' T � SAN.,JOAQUIN JOCAL HEALTH DISTRICT i ...,...�.__.....�.... r. :...�.=..�w .- - 7/72 3i�K