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— I FOR OFFICE USE: I FOR OFFICE USE: *-OAPPLIi:ATION FOR SANITATION PERMITn/ 7 �—�p Z Permit No. .... (Complete in Tri,_.izote -/ ............................ ........ .... ...... Date Issued ......... ... .... __..- .. This Permit Expires 1 Year From Date Issued App!icwion is hereby made to the;jn Joaquin Local Health District for a permit to construct and instail the work herein described. This application is made in compliance with County Ordinance No. 49 and existing Rules and Regulations: JGd ADDRE55/LOC ;IN 0y . �. ��'��4 �"' " _ CENSUS TRACT? ....... ..........Owner's Nc:me - .'�3.L, .-��l _. Phone�J�.... .� ... Address_ �*�—cam City Gi, .. ..Zips'>.7C.......... Contractor's Name..�G License # _..�_... _. .Phone _. ._. ................. o� Installation will serve: esdence Apartment House❑ Commercial ❑ Trailer Court [l Motel ❑ Other Number of living units:..... . ......Number of bedrooms.. ..Garbage Grinder Lot Size . ... Water Supply: Public System and name.. _ .. _ _ - _. . _ . ....... .Private Character of soil to a cdepth of 3 feet: Sand [j Silt❑ Cloy J Peat❑ Sandy Loam�Elay Loam ❑ Hardpan ❑ Adobe❑ Fill Material ;f yes,type . ._ (Plot plan, showing si-c a.` !ot, location of system in relation to welis, buildings,etc. mus;ue placed on reverse side.) u NEW INSTALLATtJN: (No septic tank or seepage pit perm:tted If Public sewer is available within 200 feet,) PACKAGE TREATMENT ( 1 SEPTIC TANK Size Liquid Depth . . Capacity/'�'�- .. ype _ r� s Motorial _ _ No. Compartments.... .._............ I _.. /L�... _ r ..... ................ Distance to nearest: Well.. .4,6e Foundation Pop. Line... Length of each line . ...Total Lenath . . ___._..................... LEACHING LINE [ 1 No. of Lines .. . . :........ . 9 'D' Box...... . .. Type Filter Material.. _ Depth F;tter Material. ............. .... .... ..... Distance to nearest:Well.... 'oundatior. . ._ _ .._... .......Property Line............... ................ SEEPAGE PIT Depth .. Diameter Number. .. ... .. .._ . ..... . Rock Filled Yes❑ No I 1 P _ ..............Rock Size ... ...... ............ Water Table Depth......... ..... . ... ... .... ..... _......_.. .... Distance to nearest: Well.. .... . . -...- _....Foundation_ __.. Prop. Line ... .. .. _.. .__....... REPAJR/ADDITION ;Prev. Sanitation Permit#,f. Dote ..... 11 X l Septic Tank (Specify Requirements) Zeh Disposal Field (Specify Requirements) .......... ....... . .... . .. . . . . ............. .................... .. (Draw exis+Ina and required odditioo on reverse side) I hereby certify that I have prepared this app icotion and that the work will be dine 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 6ertifies 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,fub)ecttttoo Workmon•s Compensatit n laws of Califon:ia." Signed /� 0wnw / T'.tle (If other than owner) Foj6DEPART4A ENT USE ONLY �.,Cyi�'(11 (",/ DATE ✓ APPLICAT!ON ACCEPTED BY/-' �,� f % - DATE DIVISION OF LAND NUMBER / ADDITIONAL COMMENTS Date C� '^��•J��_ 1 Final Inspection by. vas 21677 REV.7/76�M EN 17 24 � SAN JOAWIN LCCAL HEALTH DISTRICT 1.