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FOR OFFICE USE: FOR OFFICE USE. <br /> '-` APPLICATION3F,0k SANITATION PERMIT <br /> Permit No. <br /> (Complete in Triplicate) <br /> Issue <br /> '-------------------------------------- ------------_ <br /> Date <br /> -- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in comphice ith County Ordinance No. 549 and existing Rules and Regulation: , - �. <br /> . vy <br /> ti <br /> t <br /> JOB ADDRESS/LOCATI `-.-_-- o.- .CENSUS TRACT--------------- --- <br /> r <br /> 1 --- - -- -------- - -------- <br /> Ow'ner's Name.: _, <br /> - ' ---- - .Phone -- ---- <br /> f �r <br /> Address----- -- -, -�--------- rY. ------- -City Zip _ <br /> f <br /> T <br /> �.. <br /> Contractor's Name ..a9i.._ -.A -47-kicense # r��-`�---------- <br /> hone. <br /> P <br />` Trailer Court <br /> Insta{lation will serve: Residence Apartment House.❑ Commercial ❑ ❑ <br /> - Motel ❑ r---:`------------------ - -------------------- �t. <br /> Number of living units:-.-- -----.-Number of be rwaf �Ghn __ nv_----------- <br /> Water Supply: Public System and name-- Private <br /> e <br /> Character of soil to a depth of 3 feet: Sand 0 -Silt❑ ,Clay ❑ . Peas`E] Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan E] Ado6 ; Fill Material--.--------_Ifyes, type--------------------- ----- <br /> 4 <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildindsetc. must be placed on reverse side.) <br /> 4 i �.i. .. .s.,-septic - <br /> seepage <br /> Pie _ - * thin 200 feet,) <br /> PACKAGE INSTALLATION' '(No <br /> [(I]o SEPTIC TP see a e . it e5rmitted if sewel 4 <br /> er is available w Liquid Depth-" __ s____ <br /> �/j� I # <br /> ` Capacity/-Iae z-TYPe - � 'Materia -------------- No. Compartments <br /> ;oe <br /> f_ ------- ----- Foundation-- -- - -P p_ Line ------------ <br /> e <br /> ------- - <br /> ., _ Distance;to nearest:�,W.ell_--_��?�-__--- _ . 1 <br /> --____;_ Total,-Len , <br /> LEACHING LINE. No..of Lines-' -----°-- --�=----.Len th o each {ina.-- -�--- � ..- --- gth.,_-- _�--------- - e <br /> �r - <br /> - ,p <br /> D' Bax__ .._ --- a Filter Material'- _ ---Depth Filter Material---- L--- --- -----=------------------------------- <br /> -Type ;- --------------- <br /> Distance to nearest: Wel!- ___ 1__ --- __ ____Property Line <br /> Foundation ff� <br /> p, . ...�a . .- <br /> �. -- --"Diameter - Yes <br /> i ,S `° . k_-Number--- <br /> SEEPAGE <br /> P1T depth-, "--:- _.. f <br /> .. . ' . _ '^. `Rock Size`_ -------------------------------------- <br /> Water <br /> ..-`-------- -------------- <br /> Rock Filled No.❑ <br /> Water Tab <br /> le ------� <br /> , S o f dotio Q" �' <br /> Distance.to nearest: Wen___ _ _ _--_-__-. p. Line__"_ --. , <br /> II - F u , <br /> REPAIR/ADDITION (-rev-Sanitation Permit#------_-'- ----=- Date---------------------------------------- 1 <br /> .. ..-. p.._ : --- <br /> Septic Tank (Specify�3Require�,entsf- ----------- ----------- =----=---------� -------- -------------------------------------_ ------- <br /> A f t. $ <br /> Disposal Field .(Specify Requites ments) ':. - -- --- ----------------- --------- <br /> -------------------------- <br /> ------ <br /> -------------- ------- ----- --- .----------------------------- <br /> _K ----------------------------- -------------------- - , <br /> --- ---.----- -- --------------- --------- ----------------------------------------- <br /> ------------------- <br /> ;._.. <br /> (Draw ezisting;dnd`req iu red addition-on reverse side) M <br /> I heieby certify that�1 have prepared this applica~t or n and that the work will be done in accordance with San Joaquin County <br /> Ordinances,S�State Llaws, and. Rules andAegulations of:the:San Joaquin Local Health District. Home owner or licensed agents <br /> 1 = ` <br /> signature re' rtifies thfollowing: <br /> "1 certify that in the performcincefof the wwkAor which this permit is issued, I sFigli�not empfo any esson in sack manner as <br /> to become subject. to Workman.s.Compensation laws of California." <br /> 9[ i - CLARENCE'S SEPTIC & S,EVdER SERVICE. € <br /> �[ <br /> Signed----- _ . .: - _ eer 63 So' Ora Stockton, <br /> (. 9520 <br /> ::- <br /> # Plt 4 Gos�tsasto5'5�uc:#Z671�_.---- <br /> By-- ---- ;. <br /> 63-32#3 <br /> + {1f other than oe <br /> ,r R`DEP RTME T 'E ONLY, m. .. P. . <br /> �.. � . <br /> APPLICATION ACCE.PTEQ BY-------- -If - -- e_-�------ T <br /> DATE - S_ ; <br /> -- - -- ---- .-DA Et <br /> r __ <br /> DIVISION OF LAND NUMBER.__ �_ - = - - _ - - A <br /> ADDITIONAL COMMENTS..-------[y -- C <br /> t ------------- --- -------------- <br /> = _--- -- --- - -------------- <br /> ---------=----------=------------- ----------- <br /> __ <br /> T <br /> ., - - a - <br /> 1 <br /> --nal-Ins ection b <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7176 3M <br />