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FOR OFFICE USE: APPLICAT , 1_- __ ___- __ SANlrar R !ON PERMIT -~=-------- --- - _ (Complete in nPfcatel d Perm it.No: .. This Permit Expires t Year From Date Issued Da - te Issued - 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 ith County Ordinance No,. 549 nd existing Rules and Regulations: � � , . JOC3 ADDRESS/LOCATION .- _ _-_- �s CENSUS TRACT Owner's Name _'''� s -. ;_Phone S _ Address,�d� ;r.�� - .__ -• --- _ City Contractor's Name - _ - - ---- -.-------- Residence Apartment-House Commeicense # , Phone � Ts Installation will serve: - � - - � -°•--• --�-_ rcial-kfra!lerCourt Motel ❑Other__--- --- _-- Number of living units:------------ Number of bedrooms ------------Garbc!ge Grinder----------- Lot Size; IWater Supply: Public System and name ---------------- - .Private 'Character of soil to a depth of 3 feet: Sand'[? Sllt[] Clay Peat❑ Sandy Loam El ClayAoam All Hardpan ❑ Adobe Fill Material__ If yes; type __: (Plot plan, showing size of loft, location of system in relation to wells,'buildings, etc. must, be . . { NEW INSTALLATION: placed .on.reverse.side.) {No septic tank or seepage pit permitted if public sewer is available within 200 feet,] t ' PACKAGE TREATMENT [ ] SEPTIC TANK �' -OC - --- Liquid .Depth:---- -------------- Ca acit P Y -- -�- --- Type _�__ Material- No. Compartments Distance to nearest. Well ---Foundation-R- ?--------- Prop.' Line - � LEACHING LINE / � p .- ---•%��r.(, No. of Lines /10------------------ Length of each li - a4-__-- ` �l Total, Length f 3---------- D' Box —------ Type Filter Material L7_i Depth Filter Material ,_10.0-- Distance to nearest: Well �DQ �_�-- Foundation * a -_ _:__ .. : Property Line j . t SEEPAGE PIT �- � � ,,, --- -- p rty [ Depth --- _ _ __-- Diameter ------- Number Number ----1 -------------- Rock Filled Yeses No z Water Table Depth _-__-_--__-- P .�^ . .: t m. Rock Size I]iatance to nearest: Well _---� � +�.. a .. ,: f. ----.•------- --Foundation : Pro Line REPAIR/ADDITION[Prey Sanitation Permit# ________------------------------------------__ � . p• _., Date ------------ --------------------- Septic Tank (Specify Requirements) -______-. ----- ---------------------------------- ----- ---- a •Disposal Field [Specify Requirements] -__;______ ------------------- - _ _ J ------------------------------------------------------------------------------------------------- __-- ___--_ _ __ [Draw existing and required addition on reverse side] -------------------------------------------------------------- I hereby certify that (have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State haws, and Rules and Regulations of the San Joaquin Local Me-" sed agents signature certifies the following: lth District. Home owner or licen- "I certify that in the performance of the work for which this permit is issued 1 shall not employ an - M as to bec mejsb�jert�W�=ompensation laws of California." p y y.person in suchmanner Signed __ - Owner -- ------ Title -- ------------------------------------------- (ift other an owner] -F t OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BUILDING PERMIT ISSUED ------------- �----------=-------------------------------------------. DATE -----E' 6 , -------- -------------------------------------------------------- TIONAL COMMENTS ------------ -� _�._��-------------- DATEADDI --------- ---- ----------------------------- -------------------------------------------------------------------- -------------------------------------- - --------- -------------------------------------------------------------------------------------------------------------------------- G- - --------------------------------------- ------------------- --------------------------------------------- Finai Inspection b -------,Date SAN JOAQUiN LOCAL HEALTH DISTRICT E. H. 9 i-'68 Rev. 5M.