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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No.__7i - ----------------- ..................... ----------- --- -- (Complete in Triplicate) O ------------------ -- i Date Issued- _------------ ----- This Permit Expires 1 Year Frons 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 anq Regulations: � -- o � CENSUS TRACT-- •---- --- ------ --- JOB ADDRESS/LOCAT12IN .15 1 -' �`�= r Owner's Name._ �G -''� - ------------- ----- - Phone = -� zi Address t City - �_..� C`-=---�-`-`- -- P ; Contractor's Name_ t{'-rte'a -tom .-•, '` - "ems -L'+cense # l._r�7--Phare Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other------------- - --------- ------------- Garba " ,^` --------------------- --- - Number of living units:._ _.-.---Number of b droor�s :._______. ge.Gindar. --Lot Size__r___- ------ -------- ----------Private ❑ Water Supply: Public System and name------, 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: tNo septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK ., Size_ J.r __ � - --' Liquid Depth." ----------------------"1 .- Capocity/616 _0.64 Type_ -----_-__ Material ' --- ---`--No. Compartments___`- Distance to nearest: Well'__- - ------- ---Foundation. -_-__ ___..Prop. Line___-- ---------------- l -.Length of each line--------- ---- "------------Total Length.----------------------f--------------- N LEACHING LINE . [ ] No. of Lines-------- _____________ __- _ 'D' Box-------- -Type Filter Material _________----------Depth Filter MateriaC+__`,_________._ ----------� Distance to nearest. Well----------------------------Foundation----.---$------------------Property Line----------------------------------- SEEPAGE PIT ]� ] Depth----------------Diameter--------------------Number------------------------------ Rock Filled Yes E] No❑� t �6 Water Table Depth---------------------------------------------------------Rock Size--------------------=--------------------- ` Distance to nearest: Well---------------------------------------- ---Foundation-----------------------—Prop, Line.: :-----------.---------- -- REPAIR/ADDITION (Prev. Sanitation Permit#------------------------------ ------------------Dote-------------------=-------- ---- Septic --;Septic Tank (Specify Requirements)---------------------------------------------------------- ------------- ----------- - ------- ---- -------- ---------- Disposal Field (Specify Requirements)---------------------- --- --------- ------------%_111----- ---------------------- --- ----- y 4L -------------------- - --------------- --- --------------------------------*'------------- ` accordance with San (Draw existing and required addition on reverse side) hereby certify that I have prepared this application and that the work will be done n 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 to become subject to Workman's Compensation laws' of California." ]CLARENCE'S SEPTIC A SEWER SERVICE Signed-------- - _.__ nCalif. 5205 Owner 263 5a. Oro � Stockton, Ca 1. Ph.463.3209 Contractor's Lic. 2b7i77, "f '' --- - --fit . Title--------- ---------- - (If other than ow r) FOR DEPARTMENT USE ONLY / t DATE.__/_-//__'- --------------------- APPLICATION ACCEPTED BY-------- ------- - f ............................ ------------DATE ------- ------= ------ ----------------- DIVISIONOF LAND NUMBER-------- ------- --------------- ------------- --------------- -------------- ----------------- ADDITIONAL COMMENTS-------- ---------- ----------------------------------- ---- ----------------------------------------- --------------- ------------------• -_-------- ----------- ---------------- - -Y Date - ` Final Inspection b p EK 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 REV. 7176 3M