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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT t Permit No. -------------------- ------------------------------------ (Complete in Triplicate) --------------------------------- Date Issued = = This Permit Expires 3 Year From Date 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 with County Ordinance No. 549 d existing Rules and Regulations: J- -CENSUS TRACT --------------•--•-------- JOB ADDRESS/LOCATIO -�- ��--- --------. �Q l - s- e—c?-------------------- -----------------Phone Owner's Name _____ -- -- ------ Address ---------- _ Cit ------- - -----•----------•-------- • ' `V------------ Y ' f — License # Phone y� -----•----- Contrartor's Name�-,_-- ------ --`�---�-� ----- -------------- Installation will serve: Residence ❑ Apartment House❑+Commrcial ❑Trailer Court ;❑ Motel ❑Other --� ______ � . �- ---------- Waterof living units:_---�---- Number of bedrooms --_2-_Garbage Grinder ---__------ Lot Size ------------------------ Water Supply: Public System and name -------------------------- Private Pt Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay Peat ❑ Sandy Loam ❑ 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 is available within 200 feet,) - PACKAGE TREATMENT [ ] SEPTIC TANK Y � Size_� /A __--f---t ----`5---/-- ----N--- Liquid Depthth --- -------------------- a• Compartments _--.P----------- Capacity eTYPe Ma-terial _.---- - ----___.-----• Distance to neaWell -------- ------- --------Foundation . ----- Pro Line 11 LEACHING LINE [ No. of Lines ------------_---------- Length of each line--- — -A....----- Total Length _--/--6..0. 'D' Box --- ------ Type Filter Material ------t-$_k._____Depth Filter Material ------If-- ------•--------—---- Foundation --..l0---- ��-----• Distance to nearest: Wel[ ------��---�____---- - �---------- Property Line --- .......... SEEPAGE PIT [ Depth ------ Diameter - -`r.__-- Number --------- -------------- Rock Filled Yes j No C3 Water Table Depth ------------- �_� ------------ -------Rock Size _ll __•• _ --`� Distance to nearest: Well ---------1-0-j-....................Foundation !C'-------------- Prop. Line ........ REPAIRfADDITION(Prev. Sanitation Permit# --------_----------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) -------- ----------- ---------------- ---------------------------- - Disposal Field (Specify Requirements) --------------- ---------------------------- ------------------------------- ----------------------------------------------------------------------------- ------------------------------------------------- -------------------- (Draw existing and required addition on reverse side) I hereby certify that 1 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-Son Joaquin Local, Health District. Home owner or licen- sed agents signature certifies the 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 Workman's Compensation laws of California." Signed ------------------------ -- ------------ =------ --- lowner Title ----la ----- -------------- ------------ (If other than owner) r " FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- - ----------------- -----------. DATE _ �'.�- ---------------- ----- ---------------------------------------------------- BUILDING PERMIT ISSUED --------------------- -------------- DA7� ADDITIONAL COMMENTS ---------------------------- - --------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------:------------------------------------------------------------------------------------------- - ---- -------------------- ------------------------------------- ------ - ------ - -- -- --------------------------------------------------------------- - -- ---- ----- -- - Final Inspection by: -------_.Date -- -- -----------Z-- - 5AN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M