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FOR OFFICE USE; This Permit Expires 1 Year From Date Issued Lot Size.. Private Clay Loam Q LEACHING LINE 1)0 XiSEEPAGE PIT No (If other than owner) FOR DEPARTMENT USE ONLY W-io-ig Date SAN JOAQUIN LOCAL HEALTH DISTRICT .....Rock Size.. Foundation... Date DATE DATE Signed... By XPPLICATION FOR SANITATION PERMIT (Complete in Triplicate) FOR OFFICE USE: City.. License # JOB ADDRESS/LOCAT Owner's Name Address I Contractor's Name Installation will F&S 21677 REV. 7/76 3M Sand Adobe-^ APPLICATION ACCEPTED BY. DIVISION OF LAND NUMBER ADDITIONAL COMMENTS. . (Draw existing and required 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 licensed 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." i . Owner i Title ,X.................................. CENSUS TRACT . Phone. fjrz.-r’zzy Zip >.... Phone Commercial Trailer Court I Depth. . Water Table Depth Distance to nearest: Well REPAIR/ADDITION (Prev. Sanitation Permit#........ Septic Tank (Specify Requirements) Disposal Fieljd (Specify Requirements) on reverse side.) seepage pit permitted if public sewer is available within 200 feet,) Size .. ..................Liquid Depth Material...C/T>G^—.r No. Compartments . ....................Foundation...(.0 Prop. Line... Length of each line ... S'O.' Total Length ... Depth Filter Material Z.5*. Distance to nearest: Well.. Foundation...ZO./.TfT.Property Line.....-^’ Diameter.. .5^Number. .................. ........ Rock Filled Yes Prop, Line .............) Silt Clay Peat Q Sandy Loam Fill Material If yes, type (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed NEW INSTALLATION: (No septic tank or PACKAGE TREATMENT [ ] SEPTIC TANK J*) Capacity Type • Distance to nearest: Well... No. of Lines .Zr 'D' Box Type Filter Material. Final Inspection byi . ^^-A EH 13 24 '— Permit No. Date Issued./.yt?^..../?^ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described, is application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: ATkON se<ve: Residence Apartment House Motel Other Number of (lying units:Number of bedrooms Garbage Grinder Water Supply: Public System and name Character of soil to a depth of 3 feet: Hardpan