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FOR OFFICE USE: <br />Lot Size <br />Clay Loam <br />LEACHING LINE <br />SEEPAGE PIT <br />.1. <br />....DATE <br />DATE <br /> <br />Final Inspection by: <br />EH 13 24 <br />(Draw existing and required addition on reverse side) <br />----- —* work will be done in accordance with San Joaquin County <br />--------s owner or licensed agents <br />T <br />.....Rock Size. <br />Foundation.. <br />Date ........... <br />Signed <br />By ... <br /> APPLICATION FOR SANITATION PERMI1 <br /> (Complete in Triplicate) <br />FOR OFFICE USE: <br />Permit No.z7^r-?^>./Z <br />Date Issued /O <br />....... City...^..T.,..,..,.^. <br />.........License # <br />Commercial^Z <br />NEW INSTALLATION: <br />PACKAGE TREATMENT <br />Date...... 1 k- IS .................... <br />F4S 21677 REV. 7/76 3M <br />Private <br />CENSUS TRACT ...................• , <br />Phone,7.^./ <br />.....- Zip .................. <br /> Phone. <br />Trailer*Court< ? <br />f other than owner) <br />■ Zr A 7 F0* DEPART^ENT USE ONLY <br />............................................... <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />........Property Line....J>.......... <br />Rock Filled Yes VT <br /> .yy"x../'6-".......... <br />... rO '/• p,op Line. 5”./*. <br />..........................) <br />I hereby certify that I have prepared this application and that the i.?. .J" 1 ... <br />Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home <br />signature certifies the following: <br />“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 <br />to become subject to Workman's Compensation laws of California.” <br />i <br />Owner <br />Title.... <br />Peat Sandy Loam <br />...If yes, type <br /> <br />............................................ -.......... This Permit Expires 1 Year From Date Issued <br />JOB ADDRESS/LOCATION //0/QO^CENS| <br />Owner's Name.......... ......(/ZX-v x — ____, <br />Address ... .....,..City <br />Contractor's Name <br />Installation will serve: <br />Non <br />1 <br /> £ <br />APPLICATION ACCEPTED BY. <br />DIVISION OF LAND NUMBER <br />ADDITIONAL COMMENTS <br /> <br /> <br /> <br /> gWiJifc:::: <br />etc. must be placed on reverse side.) <br />seepage pit permitted if public sewe^r is available within 200 feet,) <br />- Size ............ ----------Liquid Depth <br />...Material.C3iT£^'C—<... No. Compartments____,"j2 <br />ZQ2?....^7 Foundation (Q...............Prop. Line..* <br />Total Length /.GO..... <br />Residence Apartment House <br />Motel Other............... <br />Number oi. living units:Number of bedrooms '.Garbage Grinder <br />Water Supply: Public System and name.!.. <br />Character of soil to a depth of 3 feet: Sand Silt Clay <br />Hardpan Adobe Fill Material . . <br />(Plot plan, showing size of lot, location of system in relation to wells, buildings, <br />(No septic tank or <br />[ ] SEPTIC TANK <br />Capacity. <br />Distance to nearest: Well.............. Foundation <br />No. of Lines fTrrr................Length of each line ...S^) >vimi uc< <br />'D' Box. .. A<£Type Filter Material. AdJV Depth Filter Material ./S'./7 <br />Distance to nearest: Well .Z^..Q.7.... Foundation Z O. 7 <br />Depth ..Diameter . . ...Number ........................ <br />Water Table Depth...... <br />Distance to nearest: Well <br />REPAIR/ADDITION (Prev. Sanitation Permit# <br />Septic Tank (Specify Requirements)......... <br />Disposal Field (Specify Requirements)/)