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FOR OFFICE USE:' ` APPLICATION FOR SANITATION PERMIT -------------------------------------------------------- (Complete in Triplicate) Permit No. -- *= ------------------- 1 Date Issued _--_____ _______________•_ This Permit Expires 1 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 and existing Rules and Regulations: LZQ JOB ADDRESS/LOCATION - J? •j-----r ----�_\/4- ,R- 5----------------- __ CENSUS TRACT _ �-_!___ __________ Owner's Name ---- ----t)jtj-N-- - hone - -- r �- Address ------ QJ_ 1`_ L? City - ------ --- -- ------------- . T l �q Contractor's Name ----0- - �_K------- ----------------------------------- ------.License # --------: ,�__ Phone,.- •- -- 'ar -------------- Installation will serve: Residence❑Apartment House❑ Commercial ❑Trailers Motel ❑ Other ______-_ i Number of living units:__/-___ Number of bedrooms _ l.____Garbage Grinder _ _ __ Lot Size �� -�� -------- Water Supply: Public System and name --------------------------------------------------------------- --- - _ Pl;vate' / i - 't; Character of soil to a de th of 3 feet: Sand' SiI Clay Peat .Sand Loam Ciay Loam ❑ p ❑ Y ❑ ❑ Y Hardpan Adobe'❑ Fill Material W lf yes, type ----- --------- ,;__ , (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) JU NEW INSTALLATION: {No septic tank or seep it permitted if public: sewer is available within 200 fget,),l f� Q v. PACKAGE TREATMENT [ ] SEPLIC-TANK -- yy�� Size,__ __XI®_ t __________ Liquid Depths_______________ Capacity, 120-0-- Type l-R FFP Material-(20aC.K-T No. Compartments,]-. _ .:Z z'I"istance to nearest: Well ____ �--- ______________Foundatifon g O._`------ Prop Lane -_,------- s ---------- ------ - 1, � I I i LEACHING LINE No. of Lines ___ Length of"each line__ ___7,5,*,---!____ Total Length _/_._...__ ['. D' Bo/j`— Distance S Type Filter Material _ _ _�K_Deptk Filter, Matenai ----to nearest: Well __ Foundation __ O___' `_.`Property Line = SEEPAGE PIT Depth ________:.._ Diameter ,yk_- Number _____/___________r_ __ __ Rock i)leA, Yes No ' Water Table Depth � -.____---_Rock Size�- _ , ioDista.nce.:t&hebrest. Well -__ _& -__ -__ _ ._._Foundatn ®i Po line ____` REPAIR/ADDITION(Prev. Sanitation Permit# ------------------- Date __ _________________ ____________) Septic Tank (Specify Requirements) ---- - `--- - - --- ------ ----- - - ----- - • ------ -- -------- Disposal FieldySpecify Requirements) ----- --CF_'-P_h----_ - ---- --- � - -- - - - - - ---- -- ----------- - - f r (Draw existing.andrrequired 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 District. Home owner or licen- sed agents s' store certifies the toll ingLtimn "1 certify th tin the e`rforman o the wwhich-this this permit 6s issued; I shall not employ any person Ira such manner as to beco sub` ct,to Work' n Comp of California.Signed .. -- --- Owner BY ---- ' -------- --- ---1-- '�` ---- ---- -- -------- ------ -�1 /Title --------------------------------------------------- - (If other than owner) 4 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY 1 DATE 77 BUILD.ING._P.ERMI.T,._ISSUED------------------------------------ --------------------------- - _- <._ ., -- . ADDITIONAL COMMENTS - ------------ ---- 42,� -------------- - -- - --- ----- - ---- ------------------------------ r t -- - --- - - -- -- ------ - -- --- - - ------ /e� _ - ----- - - - ---------Date /_ --Final Inspectio _ _ _ _ __ _ __ __ _______ - _-- -- -- SAN JOAQUIN LOCAL HEALTH DISTRICT _ - E. H. 9 1-'68 Rev. 5M