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_ -FOR OFFICE USEt APPLICATION FOR SANITATION PERMIT <br /> . ................................................. (Complete In Triplicate) <br /> No.�.�..a. � <br /> ................................................. Date Issued...... This Permit Expires 1 Year From Date Issued lP....tf-.7. 7 <br /> d <br /> Application is hereby made to the Sar► Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application Is made in compliancce�with County Ordinance No. 549 and existing Rules and Regulatlonse <br /> JOB ADDRESSAOCATION ..... ... . ..L: C i?. .......................CEIJSUS TRACT .......................... <br /> Owner's Name ...................... ...... .... ................ :...... hone .---......._...:.....:..... :...... <br /> I Address ................. .. r . ...... .. .. .._....•.. ........... ............City ................... <br /> . .... <br /> Contradar's Name . teP- ._ ...el�•1�:.Lioanse #�;ZG..'7�7.°l. Phone - �.L�• -��- - <br /> Installation will serves Residencep(Apartment House C] Commercial❑Trailer Court ❑ <br /> Motel❑Other............................................ <br /> Number of living unitis.....4 Number of bedrooms ... rbage ander ..` � Lot Sise <br /> Water Supply, Public System and name :�r .:4��.�..... r.. .. ?.....................................................fMivale <br /> rAs <br /> Character of soil to a depth of 3 feet: .Sand❑ Silt❑. Clay ❑ Peat❑ Sandy Loam ❑ day Loam ❑ <br /> ' Hardpan❑ Adobe hX Fill Material .If yes,type.. :^............. <br /> (Plot plan, showing size of Tot, location of system in relation to wells, buildings, etc: must be placed on reverse :lds.) <br /> NEW INSTALLATIONS , (No septic tank or seepage pit permitted If public sewer is available within 200 feet,► <br /> PACKAGE TREATMENT ( ]: SEPTIC TANK S120. ..� `..IV..... ...... Liquid Depth .......................... <br /> ' Capacity/,2ap.4; . TypeMaterial._ No. Compartments,,,a�................ <br /> •t ...--•.............Faund6on �Distance to nearestt Wellti ....... Prop. <br /> Line ... t?r <br /> LEACHING LINE .No.,of Lines ....:r............... Length of each line...... T............. Total Length .Yzo............. N <br /> 'D' Sox ./.......Type Filter Material A .....Depth Filter Material .f9.................................. <br /> Distance to nearest, Well 4S.l)........... Foundationhr Property Line ...-. <br /> SEEPAGE PIT , Depth .a.<$ ...... Diameter ..7:4!... Number ......5. ............... Rock Filled Yes , ' ...No.C3 <br /> Water Table Depth .....- .Fa-.. ...... ................Rock Size .. .F -`.................. _ a <br /> Distance to nearest: Well .....14W..`...................Foundation .... ...... Prop. Lina .S <br /> ..-------Y <br /> REPAIR/ADDITION(Prov. Sanitation Permit# ............................................ Date .............. ........ . .I t <br /> ---.................................................. ............................... . <br /> Septic Tank (Specify Requirements) ......................................... ....--- "I <br /> -Disposal Field (Specify Requirements) ...................... ..... ............................................ ......................._.................... <br /> ......------•--------•-•........................•------------........._.............................................................................................................................. <br /> ....... .. ........................................... .......... ........... .... ......................._ .. ............................................... <br /> (Draw existing and required addition on reverse :idol <br /> 1 hereby certify that I have prepared this applications and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local. Health District. Home owner or Ilten- <br /> sed agents signature certifies the following- <br /> ") certify that in the performance of the work for which this permit Is Issued, 1 shall not employ any person In such manner <br /> as to become subject to Workman's Compensation laws of Californla." CLARENCE'S SEPTIC & SEWER SERVICE <br /> 263 So. Oro � Stockton, Ca'if. 95205 <br /> Signed ................................................................ ............................... Owner f <br /> B (�, Title ......... �:453.320.. Contractor's Lic; � j j-..... <br /> y .......... .. <br /> Of other than owner! <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED 8Y --- -. ... ........ DATE ..�-.�L..7�7. <br /> BUILDING PERMIT ISSUED ................................................ ................DATE ............................. <br /> ADDITIONAL COMMENTS ....................................... <br /> ' '2....•...... <br /> .......................................... :- __ ?_f -........::�a:- t: ' ----- ....................................-...........:..:.... ........... <br /> .................. <br /> .................... ----------------------------------------•.................................................................................................I...... <br /> Final Inspection by: .. Date l... .. <br /> Etc 13 2a 1-•68 Rev. 5K SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />