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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------�uJW-- Permit No.,7g__��7 Q0 '1 (Complete in Triplicate) ------ ----A- t Date Issued_=_��"_�� ------- - ---------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Locale 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 ay-fisting Rules and tqulat'ons: JO�ADDRESS/LOCATI N -�- c . s CEN_ _.. . _... SUS TRACT __ Owner's Name - -- ---- - - - ------------ - - -- -- -- ------ -- - - - ---Phone-------------------------------------- e-7 -- --- - --- - ---- 11' Address - City -Z�p Contractor's Name ' .4�LZ44,License #- -- _�_Phone4e Installation.will serve: - Residence Apartment House.❑ Commercial ❑ Trailer Court ❑ _�_.._._ �____1__�_.-_ Md#el ❑ -�3ther== - Number of living units:----- ------Number of b drooms ____ ____.Garbage Grin er_^ -Lat Size_______ ___-_____- Private Water Supply: Public System and name------ - - ---------------------- ❑ Character of soil to a depth of 3 feet: Sand ❑ Silt❑ '=Clad ❑ Peat❑ Sandy Loam Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Materiat___`>.___If yes, type________________.____.___---- t (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reve-r�#side.)-. NEW INSTALLATION: (No septic tank or seepage'pi p'ermltfed-i public sewer if available wifshirt20,dfeet,) / PACKAGE TREATMENT [ ] SEPTIC TANK X ...._ .�Itz __X 1 - -��r-- __ -_-_ Liquid DepriM._ ----------------- --.Capacit� t��/'_ i�,�(,Type_ _ _ terial _ i0�C�4Gl_NoA Comparxmn3s -. --------------- Distance to nearest: Well--- _4�✓.1 ---------FoUndat►on_ - _------- Prop. Line____._____. ___ ___. LEACHING LINE No. of Lines_;__------------------Length of each Iinei ------.Total Length ---- 1/- -a--�- ------ } 'D" Box /___Type Filter Material__ ___ __.DepTh-Filter Material------Ap----------------------------------------------- Distance to neajest: Wellr�`+e�4✓ _ .FoundaticpM - a-_ __`-Property Line _____�_______ ----------- SEEPAGE PIT ( Dep th.oT�___Diameter...... *t_ ---Number------- _ Rock Filled Yes No❑ Water Table Depth-_. - -----------Rock $ize -&I ---- -------- -- -------- / � r\ Distanc"e'�o nearest: Well _�' _ Foundation _L__ Prop. Line __ � -____ ________. REPAIR/ADDITION (Prev. Sanitation Permit#--__________--------------------------------------Date___. .________s_-_-----------.--) Septic Tank{Specify Requirements)---------------------------------------- ------ ------------------ - - - - Disposal Field (Specify Requirements)__. --------------------------------------- -------------------------------------;---- ---------------------------------------------------------- --------------------------------- ------- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work wild be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District;.Bome owner or licensed agents signature certifies the folrawing: "1 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 & SEWER SERVICE Signed____ -- - ------------------------------------- --"--------- -------------_-.-Owner 263 So. Oro ,, Stockton, Calif. 95205 BY ( �� - Title-------------- Ph.463-3209 Contractor's Lic.#267177. (If other than r) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- - --------------------------------------------------------------------DATE.--- ---------------- DIVISION OF LAND NUMBER.-- ---- --- - ----/J -- --- --- DATE-------------------------------------------------------------- -ADDITIONAL COMMENTS --- ` X12 7� �" - ---- --- - - - -- - --- -- -- -------------------------------- --- - - ----- --- ---------------------- - --- ---- - Final Inspection by;___-_ - - ----- - ------- ---- - - --Date-_ �1�!--- EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&s 21677 REV. 7/76 3M