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FOR'.OFFICE,•USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ., ------------------------------------------.e...._. ._. .__7 (Complete in Triplicate) Permit No - -. Ac x J� 4 Date Issued-.l.-/`'_� Lr---- - This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local HealthiDistrict 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: JOB ADDRESS/LOCATI N......1 0 ------ --- --- :------ --- ---- r--- ..- .CENSUS-TRACT----- - ------------ ---- .- Owner's Name. --------- ------------------------ Phone -.i-. . Address --- --- F L ---------(fit? - ---; --- -- --- -'------- ------------------ -City-_ ---- --- -- -«'"1-----zip------------------------------ Contractor's Na`m .__ .s._._ .dr.�. .�1✓r�sr�+.e.�License #- - -- 1_ _~f_Phone_�_-f_ - C Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ ' Other------------ ----- Number of living units:.---L- .--___.Number of. be rooms_.:_ ._.__Garbo e Grind of Size------- // g g � .-1 --, , Water Supply: Public System and name__._____ __ ___ ____ _-� ------ .� �C'�1-___-_._---------------_----- ----------Private ❑ } Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ AdobeA Fill Material------_------If yes, type___-.---__---__.---____------. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200'feet,)_: ^- PACKAGE TREATMENT [" —SEPTIC.TANK �; Size_' ° __'�� . fLiq � � 5 _�'� �� --------------Liquid De th.-� ------� Depth.--4 �--�_-•-�------.Capacityf��1�,�•-TYpe_ �-.--=- `` --I�--.-Material..__._ ----- --_ '=fVo--C-�ompar#mems_--:�-------__� s Distance to nearest: Well_`- ..4al ---------Foundation__Aa__P_________-Prop. Line---.47^7------------ L r t s ----- --- g _ 7 . . g ' LEACHING LINE [ No. of Lines-___ _-.-_- a Le�� 1 ,1 _ � Leif th•af each Tina-----�� -�--`-----Total Len--th-�---�_�`0________ _________ _ 1 'D' Box__'/__.__Type.Filter Malrenal / __ Depth Filter-Material.___ - _ ♦ --- .Distanc5to nearest: WellZ,) .Foundation-__ O___ -_ _Property L'ine. ..-a� _-_----- -_ f SEEPAGE PIT ?[ Depth- .----vDfameter_ .�______________Number_____________ RockLFilled Yes Nol Water Table Depth------- - - Rock Size... -------------------1- t ------------- { i Distance to nearest/: Well- `_ ---------- ---___-_--Foundation----lQ---_.---.--.Prop. Line------kj - REPAIR 'ADDITION (Prev. Sanitation Permit#-------------------------------------------------------Date----------------.------------------------ Sepm tic Tank (Specify Requireents.) w-- :`..`„ .` r _ �s " , - " '= ---------------------------------------------- -----==---------- Disposal Field {Specify Requirements} -------------- JL _ - - = ------------------ - - --- (Draw existing and requiredraddition on reverse side) I hereby certify that I have prepared-this-application and,that the work will be done in accolicen►itii San Joaquin County Ordinances, State Laws; and Rules and Regulations of ,the ,San Joaquin Local Health Distfict*HarWe owner of 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 esubject to Workman's Compensation- laws of California." . �t Signedt`_ _ti ti;= =._ Ownar �LARENCE'S SEPTIC & Si=WIR SERVICE # _ .�. F "1' X263 So. Oro ,, Stc,�ktorl, a,Jf`9-95205----By. - —• ----- Title_.. fTli: E -:209 Cc ---------------------------------- f5 ii c:c ;'6267177 {If other than own ( �!' ; R' EPART `USE NLY'�"�"'-'� APPLICATION ACCEPTED' BY----------+.p./L-------- .. . = -- ------------------------------------ -----DATE ------- - -- - -- ----------------- DIVISION ------- --DIVISION OF LAND NUMBER = = - -- �-- DATE. -----------^ --- -=- -----•-- i � - --- - "" _ iw . ADDITIONAL COMMENTS-------- -- __ ' �`1 -------- ---- 3 ------------------- -------- ---- -------------------------------------------'~- •_-_---F-"-�.------------------�_t--- - - -------------------- --- ---------------------- ________________________________________ _ _ _ __ _____ _____________________ ... ..�_. r-.. .. _---!_---------' --------------------- -- --'-----'..--''--- -- -..--'--.-- _ - ----------- EH ._ -. Final-4,4Aspection..by--- - - - - -- - " � """'"`'�."...... `"_,�" ��- i =�� .dam_ .. ..,r. Date_ EH3 24 i SAN JOAQUIN LOCAL HEALTH DISTRICT 1 F s 2ibn REV. 7/76 3m • � j