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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----------------------- ------- j0 (Complete in Triplicate) Permit No_______________________ ------------------------------------------ Date Issued_.__r��-�"� This Permit Expires 1 Year From Date Issued Applicat,lon 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: JOB ADDRESS/LOCATION __.�1.. 1 -! _-- --4 .__--. - -- -----_-------------CENSUS TRACT--------------------------------- -------------- Owner's, Name.------- � ......... --------------- -- Phone..------ 1 Address-------------------- �� c� / .._.. T City - ----------- Contractor's '-------- -------- f Contractor's Name., � _� .--_� -_-�4-_ :- - __.,¢r21�[J�License # - 1 - -.-_Phone___� 4"a _ _ Installation will serve: Residence )( Apartment House[] Commercial ❑ Trailer Court ❑ Motes ❑ Other-------------------- ------------------------- t Number-of diving-units: MJumber room.s-ry---Garbage Grindeer:-�Lot,Size_— =- ---------------------------- f 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_Materigl= If.,YeS,-1y-pr------ ----------------------- (Plot plan, showing size of lot, location of systefr?in relation #o k ells,' i ildings, etc. must be placed on reverse side.) NEW INSTALLATION: "�o septicvtank,or seepage pit permitted if public sewer is aiivailable within 200 feet,) PACKAGE TREATMENT [ ]" 'PEPTIC TANK { �e_______________________________________ ________________Liquid Depth. -� � Cdpacity ----------------Type-----------------------Material.------ No. Compartments--L-----------------------------~ .✓ �`l�/&stance to nearest: Well ------------------------------------------Foundn - at 4'-- .----------------- Prop. Line--------------------------- A-111 51 LEACHI NE [ ] No. of Lines-----------------------------Length of each line----------------- Total Length --------------41Z% ..0 Q' Box............Type Filter Material--------------------Depth Filter Material-----------------_------------_------_-----_-------------___--. .. t.. l Distance to nearest: Well____._____________ _______Foundation_.__.___._._-- _-____--_---Property Line-- ----- ---- SEEPAGE'PIT Depth __ __. ____Diameter_._ _ ___ Number___..____--------------- Rock Filled Yes [ No [ i i ----------------- Water Table Qepth--- ------ =C�-----------------------------------------stock Size---- - A' } -- - ! I iJaW ......... i .� r REPAIR ADDITION (Prev. � nl� '� FP rm'. , -- ----- ______________ ___ _________Datedation----.--��_ __ Pro Line_.____ ] Distance to nearest: Well G _ _. / (; e . Sa •t�tion e it# 1' � R t ) . t _ Septic Tank (Specify Requirements)_-_ _ -- ____ 'l____-_-___ _ _ -- ----- --------- ----- - ---- - -------------- -- Disposal€Field (Specify Regb irements)------ ------ -' _ - ---- ----_/ ! 1 _ -------- t . -------------- - ---------- ------- ------------------------------------------------------------------------t --`-------------------------------- t F -------------- ---------------- = y` n. } ------------------ --------- (Dri`w existing and required 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 Districf. Home owner or licensed agents signature,certifies the following: } r } � s "I certify4hat in the performance of the work-fo�'whicg'this permit is iso sued,i shall not employ any person in such manner as to become sub' to V. rkman's Compensation laws of California." CLARENCE'S SEPTIC & SEWER SFRVIC& Signed-------- _-- -------------------- ----- ✓-- ------ - ----------------Owner 263 So. Oro Stockton, Calif. 95205' -------- --- - '` Title 44 Ph- - =3?09 C^n'*3 _tic.12§7177 BY ctor's (If other tha r), —� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ ------------------- ----------DATE -!'tl l3'7 C ------------- ------ DIVISIONOF LAND NUMBER -- I----------------------- --------------------------- --------- --------DATE----------- _ ------------ ---- ADDITIONAL COMMENTS . - ---- -----v-- ------------------------------------------------ --------------------------- -----------=----------------------------- --------------------------------------------I------_-- -----------------------------------------------------.._- ----- - -------------------------------- - --------- F �Fihal"Inspection Y:--- ---- - ---------------T-----� --- -------------- � ----- ----------------�- ---Efate. EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/76 3M