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APPLICATION FOR SANITATION PERMIT -- (Complete In Triplicate) Permit No. This Permit Expires 1 Year From Date Issued 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 and existing Rules and Regulations: JOB ADDRESS/LOCATION Sy�. .7....: 1---_-1r.._33 ...CENSUS TRACT ......... ............. Owner's Name - _- 9 5 7-/9. Phone ..................... Address Sy M E' /45 �(� n✓e lie rnf,g �'rt - --- --- --- -- - ... .. --- ... ........... ............. .. ... Contractor's Name �'_ 7iu-----1--------�y- �{ y------'o!v ---....License # /6.6.-J�� . Phone ..j.. Z.3 .............. ................. Installation will serve: Residence n Apartment House❑ Commercial ❑Trailer Court C] Motel ❑Other - Number of living units: . _�___ Number of bedrooms ----I------Garbage Grinder ............ Lot Size ..'Z._A c y S Water Supply: Public System and name ---------------------- -----••--• ------------•-----...........................................Private R Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam ❑ ( , Hardpan ❑ Adobe ❑ Fill Material If yes, type ............... ............ �l (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[ ] Size................................................ Liquid Depth .......................... T Capacity ------------------- Type ------ ------- Material...................... No. Compartments Distance to nearest: Well . ----------......__...._...__....Foundation .-.--..-.._- ........ Prop. Line ...................... LEACHING LINE [ j No. of Lines __ Length of each line--------------- ----- ------ Total Length ............................ 'D' Box Type Filter Material _..._____..-.----Depth Filter Material .......... ................................. � Distance to nearest: Well __..._..__--_. ----- Foundation Property Line ........................� SEEPAGE PIT [ ) Depth ._ -__._--------. Diameter __............. Number _ --- -- Rock Filled Yes ❑ No ❑ Water Table Depth --------•-- ....................................Rock Size ................................ Distance to nearest: Well ........................................Foundation ------------ ....... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit�# -------------------------------------------- Date ............_---------------------) Septic Tank (Specify Requirements) -------------_-------- 0.._�__._��' � °'T HI 4 e GC f: L :/v L- 36 "' •-------_---- •-•---•---•--------------•-•----•-••---•--- •.---.._........---...._.... Vete'e�e o/ le.) ;s . 7A 1v-- --- --••---------�------------------------------------------------------ ---- ----------------------------K-•-----.-•-------- -- - - --------- ---- - - ----------------- ----•--- ----------------------•---•---- --------- ---•-•-----------••-•-----------•--•--------------_---•--.---•---- ----- - (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 San 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 em_olov_ any Derson in such manner as to become subject to Workman's Compensation laws of California." Signed _. _.._ -- Owner mss/ - -- ---- - - ---- By ---- FC` 4 .7�2: dx Jitle --- -- --- {If other Title er� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ G'!r---........................... ........ - ------------- DATE �r.. _. ..._._ .......... BUILDINGPERMIT ISSUED ------ -----------------------------------•--- ---•----•--•------------ ------------------------DATE - - ----•------..-------•-------- - ADDITIONAL COMMENTS ------ ----- --------------- ---------------------------------- ------••---------- ---------•------------•--••----------•-----------------------------------------------------•--------------••--- ---------------- ---------------------- ............................ �- -------- --- - - ------- ----- --- ---- - Final Inspection by: - ------------------------•----- - ----------- -------- ...... ..............Date _..... .� - ------ EH 13 21� 1-68 Rev. 5h1 SAN JOAQUIN LOCAL HEALTH DISTRICT 8711 3M