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FOR OFFICE USE: FOR OFFICE USE: .It - �.� !� APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. _._ �� r"_._._.__.. .41--------�---- !' -------- Date Is sued... i �-- -------------- So-N)_---._ This Permit Expires t Year From Date Issued -Application-is-hereby-made-to-the-SonJoaqvin•-L-ocal•-Health-'Districfifor-dpermif-to construcf and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCAT ON x =I ST ------ ---- - f�f Y - ENSUS TRACT---- ------ ..................... Owner's Name 2: = - = Phone. _-r -- -- ,. - . b - / qq -" Address-----e_(9 ---------- ------- - ------------------------- City- --- ---------- ------- -----------------ZIP --i-------------------- Contractor's Name 1. 4License i _� _7 Phane_: � ,.. z_G�..g_. Insiallation will serve: Motel P < Other______ _E Commercial ❑ Trailer Court ❑ 1 ' � Residence �--A❑artment House. Com- r- ------------- Nu ber of living units:_-'___ ------Number.of b'drooms-..�_-_-_Garbage Grinder."'��_Lot,Size_--_C.-___ ------------.._______________. Water Supply: Public System. nd name----e/ ---- --- - Private ---------------------- ,. Character of soil to a depth olf 3 feet: Sand ❑� Silt❑ Clay ❑ Peat❑ Sandy Loam L] Clay Loam ❑ f Har span ❑ ; Adobe- Fill Material__...--------If yes, type-----------------i-.____._ (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 ( page 'pit permitted if public sewer is avail 8le within 200 feet,} PACKAGE TREATMENT [ ] SEPTIC TANK" Size___"__ __- l©_.. Liquid Depth_____.-__.__'__� i d CapacitY�a�fiG�1QL- TYPe: JL. Material - -------- olr Compartments , ----=------------------ DisAnce to nearest:.Well_:._.1 ___---------------_____----------Foundation::��_____-__.___=.:Prop. Line._--------------,._.v �� / '--._Total Length.-----�da---f---------------- 10 ---.---------- LEACHING LINE No.�lof Lines.--__-_, __. k- __._..Length.of each line____ / D' Box--'&--_Type'fi!ter Material_-x _ p Filter Material-.1 _�---------------------------------- !'D' ._____ -------- --------- . .. ---Depth - -:--- - _ Foundatio . €, .. .i _ . _ 1 Distance to nearest: Well_:W___ _______ ___ n___._ f _.._'..-: T__yProperty Line-----.S_---- - SEEPAGE PIT [ Dep;h �`__-___Diameter._..._ ;____Number________ __________.__-_..._ Rock Filled Yes.. ']` No ❑ / 4 Water Table De th -----------=---------- '..---------Rock Size----------------------------------------------- -- f Dist nce to nearest: WeIT7_'_�Za_______ --------------------Foundation-----1__1Q.-.---.--.-.Prop. Line------- REPAIR/ADDITION (Prev. Sanitation Permit#--'------ ------------- ._ _:_.D ___.___.___- ------- __ ________________] r Septic Tank (Specify Require. ents)------- = - -----. - --'------------------ --�`- - ,{ � t . Disposal Field [Specify Requ'irements]- J ' ? - --- - -------------------------- - - -- = ---- - --------- --------------------------------------------------------------------------------------------------------------------- --------- --------- - ------------------------ - ------------- ----------- - - (Draw px!sting sand required addition on reverse side) hereby certify'that'1 have prepared this,application�'ancl that the work will be-done in accordance with San Joaquin County Ordinances, State:.Laws, and Rules and Regulations oFl thei San Joaquin Local Health District. Home owner or licensed agents signature certifies the follovl i ` V - t 'E 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." CLARENCE'S SEPTIC SEWER. SERVICE Signed- .__.. ��: ' Owner 253 So. r 7 t O 1 4 Storktan Calif. 95205 $ ' .Title------------=--- �_413 Y-------------- �.: 32 nt-rac or's Lic.#26717] (If other than.owner �. FOR'DEPARTMENT USE ONLY - - t APPLICATION ACCEPTED BYL;---- r ------ -----------------��---- -- ' ---------------------------- ---DATE.---- r� DIVISION OF LAND NUMBER. /- = = ® = -DATE---------------- - -------------- -------= ADDITIONAL COMMENTS-.-'� 7/� -- .-�- - -- ------ - 'rl` _ I . `--�--------- ------------------------ --------- -- - .. `- - Y -- ------ ---- ------ '--_�----�--- 4 - ----------------------------------------------- ._ Final Inspectionby � a-------- -------- -------- -- -- -- - ae ' EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fes 21677 RIv. 7/76 3M