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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: ------------------------- 7 -- --- ----- ---- (Complete in Triplicate) Permit No./�____7i� 77 -------------- ---- ---------------- Date Issued_,This Y Permit Expires 1 Year From Date Issued Application is hereby made tq'the San Joaquin Local Health District for a permit to construct and install the work her ' This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: eln described. JOB ADDRESS/LOCATION - --- Owner's Name �Ey - y,`�` RACT ____---- ll � �+ ------------------------------i Address- l � Phone City . Contractor's Nanth _ Zip ,� .,�., _ Installation will serve:: - Residence '�` `' License #_.,-_�'-�Yl_� -Phone_4ZIT-,.7209 ----7777-- --- ❑ Apartment House.❑ Commercial ❑ Trailer.Gwv*P k Mote(--o Other_. ----- ------- -----------------7777-- Number of living units:.___ -___Number;o�eclrooms___ __Garbage Grinder__=-�-Lot Size_____ ___Water Supply: Public System anc� nacre___ __ - ----- Private Ch of soil to a depth of 3 feet. ` Sand E] Silt Clay .-- -7777-- - 7777 - ❑ Y ❑ 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,) PACKA6E-TREATMENT- RtfC $ i j Size " ---- - Ca tlr(vtd-Depth. acit '� _Type_ _ atarial._ No. Compartments_ti__ Distance to nearest: Well __ -- ----Foundation--Id,r _ _ LEACHING LINE ( ' ' Prop. Line_ No. of Lines .____e_`------------------Lepgth of each fine_ ___�� _- / ____._.Total Length ____ ----- ---------7777-- 'D' Box___ _ ._ __"_�_ _Type Filter Material- ---Depth Filter Material______ _ l Distance to nearest: Well Is, r� r,/ r Foun, n --- -- 7777------Proper_ty-Line------ . SEEPAGE PIT ' Depth_�,�___-__Diameter �� p -- - -- ---------- - --- -- Number.mer--------1Z-- , Water Table Depth-- - - �� , � Rock Filled Yes No❑ - - - - - --- ---Rock Size____04 --------------------------------Distance to nearest: Well_ --- A0a J -X---------------Foundation _ �' r REPAIR/ADDITION (Prev. Sanitation Permit#____________-;__'___-. �� ' Prop, Line __ __--k_-- ------- ------.Date Septic Tank (Specify Requirements)___ _ _ _____ ------------) --- :----- --7777------------------------------------------ Disposal Field(Specify Requirements).__ f . 7777---7777-- ---- ----- --------- 7777----_.__7777-_ �... - -E-- ------------------------ ---------------- r -------7777-- r --------7777-- --- - --------- -- - - - -7777-- - - 7777- - -- - - - (Draw existing and required addition on reverse side) € 1 hereby certify that I have prepared this application and that the work will be doneµi Ordinances, State Laws, and Rules and Regulations=-of. he San Joaquin Local Health District.xd rice with owners or licenseduin County signature certifies the following: agents "I certify that in the performance of the work for which this permit is issued, I shall not employan to become subject to Workman's Compensation laws of California." Y person in such manner as Signed----- .-__ -_- - - - - CLARENCE'S SEPTIC & SEWER SERVICE 1 �--------- ----- Ownsr By..__._I_ ._-: 263 So. Oro t Stockton Calif. 95205 ------ -----------------------Title---------_Ph,-403 3209----Cootfacior' l (If other than ned i F R D ARTMEN ONL APPLICATION ACCEPTED BY__________ --- DIVISION OF LAND NUMBER------- -- ----- - 7-111-----------------------------------DATE.------- -- -------- ---- �Q - --- s- ----- t� _ --------------------- - -7777-- - - 7��-- ADDITIONAL COMMENTS----------- --- / l = -� �' -Z_ ---------------DATE--------- - - - ----Y,-' �-------- -----;-------------------------------------------- ---------------- f ,fes----------------------- - - - - ---------------------------------------------------- - - - ---- 7777-t _..- -- - 7777- --7777-- --------7777-- 7777- - - 7777 - -- - - - - ---... 7777 -- -- - __ Final Inspection by: - - --- -------f�G�_ --- 7777 - -- - -- - -- --------------------------------------------------EH 13 24Date---7777/- _ SAN JOAQUIN LOCA) HEALTI#pISTR(CT ® F&S 21677 REV. 7/76 3M