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[ FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------------------------- - - Permit No---7 7__- (Complete in Triplicate) ------------------------ - ---- --------------------- Date Issued-.f--.---.--.---. --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District 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: h _ dam. tJOB ADDRESS/LOCATION--- �- - '�----- L SUS TRA CT----- -------------------- 0 ------ - Ow .. -.. . - - o� 641 - ------ " ne Address-.- City Zip ---- ... - + License # -�r-- ----- Installation will serve: ResidenceApartment House CoPhone: _ '3� Contractor's Name--------------- ----------- - ------------- Motel F-1 ' Other----_.---� -Commercial EJ Trailer Court E]] „ ---- ----- Number of living units------ -------Number of.bedrooms--- ---Garbage Grinder_--'7*-_-Lot.Size---__. - - ---_---------- Water Supply: Public System and name----------------- --- --- ------- --__ .. --------------------------------- -------------Private Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan Adobe ❑ 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-----------------------------------------------------------Liquid Depth--------------------------- Capacity---------------- -----.-----_------------- Capacity-------'------- -----TYPe-----------------------MatE rial---------------- ---- ----No. Compartments--------- ------------------------- V� Distance to nearest: Well_-- ----------=-------------=----=-`- -----Foundation -------Prop. Line--------------- --- ---,--- UJ LEACHING LINE No, of Lines---------- ---- _ 1�� ------------------- --------- - Length each ,lino.-----tet-.. -= -, Total Length -�------ 'D' Box-..--/-.--Type Filter Material-- - Depth Filter Material--------------------------------------------------------------- `, .�. I Distance to nearest: Well-- ---�,.----:-----Foundation--_--�_s_----_-_-------.Property Line-.1.1 _--------_- --N 077--Number Number_.---- -------------'----- , Rock Filled Yes -No Q SEEPAGE PIT Depth. ;-___Diameter-._____-. __- --. ` ❑o r Water Table'Depth--------�y = Rock Size .. 1 - Distance to nearest: Well-- -- -----------------------Foundation----/a -- -- -------.Prop. Line--4 _-- j REPAIR/ADDITION (Prev. Sanitation Permit#---------------------------------------------------Date_-----------------------------_-=------------} 't Septic Tank (Specify..Requirements) —:_.--`.-;-}'' ------ -------- �` -- - -- - -- x/(63?' Disposal Field (Specify Requirements)------- "} = ----------- - -------- --_ --- ---- ----- - - ------------------------------- -- - ------------ ----------------------- 1 ----- -- --mo----------- - - - - -----------------------------------------------------------------------------------------.-------------- ------------------------------------------------------------ [Draw existing and quired addition on reverse side) ' I hereby certify that I have prepared this'application and that the-work will- be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District, Home owner or 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 ^1 /to become subject to Workman's Compensation laws of California." - Signed.-------- ---•---- -------------•- ------------- Owner CLARENCE'S SEPTIC & SEWER SERVICES - 263 So, Oro � Stockton, Calif, 95205 BYJi ------------- _. ------Title- -------1Th.463-3269 -Contractor's - r267f7------- [If other than owner) .,� FOR Pf PARTMENT USE ONLY APPLICATION ACCEPTED BY- ---- G�JlvlDATE.----�� - 9 ----f-7------- -------' DIVISION OF LAND NUMBER ------------------------- --- ----- --- ---------------------------------:.-:----------DATE-------.- --------------- ------------------- ADDITIONALCOMMENTS------------------- ---------- ----------------------------------------------------- -------------------------------------- --------------------------------- ----- -------------------------------- ------------------- --------------------------------------- ------ -•----------------------------- -- ----------------------------------------------------- ------------------------------ ------------------------------------------- ------ ------------------------------------- - --------- exo------------------- -------------- --------------------------------------- ----- ------------ ------ --- �*, --------------`--- -----------•- y 6+f3- f" Final inspection by. ------------------- - --------------------Date--: - EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&s 21677 Rev. 7176 aAA