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FOR OFFICE USEs I <br /> APPLICATION FOR SANITATION PERMIT <br />......................................................... Permit No,;', <br /> . ..................... <br /> lComplete In Triplicate) . . J d <br /> ............ ...... <br /> ....................... This Parmit'Expires 11-Year-Frorn-Date.issued <br /> Application Is hereby made to the Son Joaquin local 40a'lth Dllstrlct-fdr­�a 'permli-to construct and Install the work herein <br /> described. This application is made In compliance with County QrdInanceA No.--50.-and existing Rules and Regutationst <br /> 4 <br /> JOB ADDIRESSILOCATION-- ...... ...........CENSUS TRACT <br /> Owner's Name ... ......... .. .... ............ Phone .................................... <br /> 47 <br /> ........................................... <br /> Address ... L?a .......... .... ... ............ . .L.................atv . .11.,- " <br /> PhoneK, <br /> Contractor's.Nome-Z,' # ,.21j. <br /> Residence Installation will Resid <br /> serve: -Aponmeni,14ousagCommercloi-(:)Ttoilw Court-C) <br /> Motel O-Other................................. <br /> I <br /> -Number of living-unitsWumber of�,droorns ..;'Art'. Go a Grinder -7-i9.—Lot Sin AS <br /> ZZ <br /> . ......... 4 .... ....».----..............�.....................Privatef3 <br /> Water Sup <br /> ply: Public System, and name <br /> Character of sail t6ci,depth of 3ifeet, Sand 51' Loarn 0 <br /> 0 Silt E3 Clay (:3 Peat 0 .,Sandy Loom C) by <br /> Hardpan E] AdobeLW Fill ...... <br /> '11plot plaivshowing,--slzo of lot, location of system In relation faiwells;,'buildings, ate. must, aced on reverse side. <br /> NEW INSTALILATI641 (No 580�ljonk or seepage pit perMitted if public sewer is available wlth.]!W200 feet,), <br /> 'PACKAGE TREATMENT—(-]— ::.........-...-•------- <br /> r <br /> ........................ <br /> SEPTIC TANK f I .............t�7............................ L14uld Depth. <br /> Moteifa-1...................... No. Compartments .................... <br /> gpogit ...... ............ Type ............ <br /> a <br /> side. <br /> -------------- <br /> .............. <br /> 1101W y <br /> 7t-;-nearast: Well Foundation ...................... Prop. Line ..................... <br /> Distance <br /> .. <br /> LEACHING LINE )k No. of Lin—e% ....................... Lahgth-b-f--bach'ilhe" '===Total-Langth- ............ <br /> 4, <br /> V Box Type Filter Material =Depth-Fifter-Material <br /> ............. ......... .............. <br /> f,,'Dlstancetoneoreds Well'.......... .............. Foundation ........................ Property Line ............. <br /> SEEPAGE PIT—! ........ Dli 1;2 No 0 <br /> ....... ................. Rock Filled Yes <br /> pth cimeter Number <br /> Water Table Depth ....... ............................Rock Size ................. <br /> W611 Foundation <br /> Distance to�:hebast-i 41.............., <br /> IREPAIN/AUDMON-IPFe-v.-Sa-nifation Permit# ............................... ....... <br /> Date .................................I <br /> ..Septic Tank_ftpedfV-.-Re4uIrern9'r1ts1 ...................... ... ......................................... <br /> . ............ <br /> t <br /> Disposal Field (Specify Requl' ments) .. A . ..... ....... ......... . ......... <br /> .... ........ ........ ..... <br /> 40 0 <br /> t. <br /> ................................................... ...... . ..........::� <br /> ... .............. ..... . ... .......... <br /> ng and.Fequired <br /> .. .............. ...... .�/CA.�. .. .. <br /> ... ....... <br /> 49��� . ...... ......... <br /> �d )tionan)reverse slcle),` <br /> row existing <br /> hereby tiortIfV_that_1_havoprepared this application and that the work will he done In accordancewith son Joaquin <br /> to-unty.0rdinances.3ta te-laws,1 and Rules and Regulations of the tein Joaquin Local Mealth District. Home *Wnw or llc*is- <br /> sed agents signature certifies the(allowing: <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 <br /> as to become subject to Workman's Compensation laws of Calif&nla." CLAREf4CE-S SEPTIC & SEWER SERVICE, <br /> 263 So. Oro 'r' Stocktort, Calif: 95205 <br /> ... . .. ................ . ........ .......... ..... <br /> Signed ... �Z. .................. Owner <br /> Pf.463-3209 Contracldr,§tic.#26717Z <br /> ........................... <br /> By .......... . ....... . a........ Title .......... <br /> at erthanowner) <br /> FOR DEPARTMENT USE ONLY <br /> 7 <br /> APPLICATION ACCEPTED BY ......... ............ DATE ­3//Q .?.?.............. .... <br /> BUILDING--PERMIT-1 ....... <br /> ADDITIONAL C M ...... ..........am..WDATE............................ <br /> ....... ........"_ <br /> .....4e"� <br /> ................­.. .... . <br /> ..............*.........**...........­................ <br /> ------------------------------ .......... ............ ........ ............. <br /> .......... ........ ............­...... ............ ............... <br /> .............................. ............................ <br /> ..... ................... <br /> Final,Inspection by: ............................ .........................f?......................I........................ .............Date ........ ....... .............. ............. <br /> EH 13 2h 1-68 Rev. 5m SAN JOAQUIN LOCAL -HEALTH DISTRICT 8/7h 3M <br />