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' I'ORCE< APPLICATION FOR SANITATION PERMIT Permit No. ...�............... ...................................................... (complete In Triplicate) � - Date lssuedr., . _ This Permit Expires 1 Year From Date issued �_11, 77 San Joaquin local Health District for a permit to construct and install the w herein Application is hereby made to the liance with County Ordinance No. SA9 and existing Rules and Regulatlonst described. This application Is made 1 c07 p CENSUS TRACT 106 ADDRESS/LOCATIO -C •. •. ....._...... . ......................... ©© D ••1:... � ' ............. ...... .............._.........._.........Phone L7........ Owner's Name .. .. ......... City -..... .. . Address . ...........................................Cf ................................ ..........._.. a; G�.X7 ...................._..... a .. Contractor's Name .. ...License �. .._ installation will serve=' Bence partmeM House[] Commercial❑Tralletr Court Q Motel C)Other -------------------••----- . Number of bedrooms Garbage Grinder .....-_..••• ..................... Number of living units=•-.--.-•••• ............. I •- -�-'-� Lot Size _...._.._......Private Water Supply: Public System and name -.. :._...:-.:___.-•••._._.._._.._......".--.----------• _._.....---- �............ Character of soil to a depth of 3 feet, Sand❑ Silt❑ Clay Q Peat❑ Sandy Loam Q Clay Loam ❑ `� Hardpan(]- , Adobe Q _........Fill Material ... if yes,type""'"'""""" ••----•••-•- � . ' Ian howin size .of lot, location of system in relation to Wills, buildings, etc. must be placed on reverse aide.) (Plot plan, s9 NEW INSTALLATIONr (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) --•--- Liquid Depth ..........•-.•-•-----••- PACKAGE TREATMENT ( ] SEPTIC TANK Size.. ................................. ... P . FMaterial.......... --_. No. Com artments _..d�......... pe -• • ........ r f .Foundation �� . Pop.Line ••-.-.- . Distance to nearest: WeIY ._f�Q.-- • • ............... ^� ..... Total Length �. ....... LEAC4INGLiNE `[ ) No. of Lines -3 .. Length of each line./-.••--- •••-•- 'D' Box .1....... Type Filter-Material ...Depth Filter Material .��........._'_ ........:...... : ...............I.......... Distance to nearest= We11 .......+..•••--........ Foundation ............ "`�- •`"— _. ...: Rock Filled Yet [3 No 0 SEEPAGE PIT �( 6;-t-; Dep flfametor ................ Num er Water Table Depth ...............--------------------------- .69 .. ........ .....Rock Size _ . ._... i ......Foundation ;"'�``Prop. Line .._......_._......... Distance to nearest=.Wel! ........_.. .................... REPAIR/ADDITION(Prev. Sanitation Permit# ... Date ..................................) Septic Tank (Specify Requirements) ............................ ................................... .... .... .._ ..._....._ .....�............�.....:.... ' :. Disposal Field (Specify Requireents) •--•--._..............:..:......._.... ................................ _.........._...........,... ........:. ............ .: m .-.. .... r (Draw existing and required addition an reverse side) I hereby certify that 1 have prepared this application,and that the work will be done In accordance with San Jeogeela County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Horne owner or iicen• sed agents signature certifies the following: arson in wet, manner "! certify that in the performance of the work for which ibis permit is issued,1 shall not employ any p as to become subject to W*tkma s Compensation laws of California." 9Signed ... ....,. �............................... ._...... - ....... Owner ......-._...:............._. ......._......:.................... By .............. Sitle (if other than owner) DEP Et4 MAE ONLY — �,,. f US ...........................DAT '. ....._�_:.......:.. ..... APPLICATION ACCEPTED BY ..... ...... .. J DAT .. �. BUILDING PERMIT ISSUED '----.. ; ......... ADDITIONAL COMMENTS •-•---................................................................_....................... . .................................. .. ...---._..............•...............-----.I............,_........_.... . c. .. .......................... ... ... ....... .............Gate ... ........ Final Inspection DISTRICT 8J74 3Mby: ...lev. .... ... EH 13 24 1-0 5H SAN JOAQUIN LOCAL -HEALTH