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4 POR OFFICE ice: <br /> APKICATION FOR SANITATION PERMIT <br />......................................................... Pemnjt No. ..7? i 7 S <br /> •�� {{ f (Complete In Triplicate) •. <br />..... ......:........ .Vl.Y ...: This Peewit Expires 1 Yeas Fres DMsIssued Date Issued ..3......��.. <br /> Application is hereby made to the San Joaquin Local Health District for a permit to conshutt and Install the work herein <br /> described. This application Is made In compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION, ..,. 'xff�? .: �:. . .....(,.-4��`�....rd:e...........I..................CENSIJS� TRACT .......................... <br /> Owner's Name .L ...... ?�:.. 1 ................I. .......... Phone .................................... <br /> ....... . . . .. . ...... . . <br /> Address ....... .�/��. ` ........................ City ., . . . .................................... <br /> Contractor's Name C✓ ..t=. �_.. f,r �::�..r.4 .Y:� ::...tiasnse 1..T `.... Mons <br /> Installation will serves Residence[(Aporanent House Q Comnerciai QTraller Court O <br /> Number of living units:.....Z. Number Motel Q Other . .....Ga'ba�...••lnder ...:�' .. Lot Size ...!.a. / ..�'(..G-••(•• <br /> Water Supply: Public System and name .x� ?�``.... —C. �-:'G�:!.....I ..............»............»:...»...............Private Q <br /> Character of soil to a depth of 3 feet: Sand Q Silt Q Clay Q Peat 0 Sandy loom Q Clay !Loam Q <br /> Hardpan Q Adobe 4t Fill Moterlal............If yes,type............... ............ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATIONe (No septic tank or sespoge,pit parrrotted if public sewer is available within 200 feet,! <br /> PACKAGE TREATMENT [ ] SEPTIC TANK i ) �1��`l" A 4,gzo................................................ Liquid Depth .......................... <br /> Capacity • Type .................... Material..---................. Na. Compartments ...................». <br /> Distance to nearest: Well ...Foundation .................... Prop. Line...................... <br /> ' �l <br /> LEACHING LINE [�" No. of Lines ... ./............... Length of.�.......lirm.... . G�.�............ Total Length .. �f... ..........». <br /> r 'D' Box ..`i ... Type Filter Material of ch <br /> Filter Material Z-l`...`.. ............................. <br /> • , Distance to noorests Well ... .�1 l .. Foundation ...le'.."...:... ne Property Li �...-.». <br /> SEEPAGE PITDepth .... D .`..�.. Number ........ ./............. Rock Filled es, No <br /> Water Table Depth .... ,.1 j................................Rock Size . : ................... <br /> Distance to nearest: Well ../..��` .............................Foundation ..�:r?X`'f...... Prop. Line ..................» <br /> REPAIR/ADDITION(Prov. Sanitation Permit# ............................................ Date ..................................I <br /> Septic Tank (Specify Requirements) ........................................ .................... ..... �[............. .. ............... <br /> Disposal Field (Specify Requirements) . .rC .� ... .f . r• ..................... <br /> ..._.................................. .."�'................ .. .�`........... ,. .. ...rx <br /> ,. .. .,,��� .., s ��.......... <br /> ............................................................................................................_.............................................................---............................ <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will ise done M ascLeedanee whir San Jsogrdw <br /> County Ordinances, Stato Laws, and Rules and Regulations of the Son Joaquin Local Health District. Nerve owner or gteer <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person In such manner <br /> as to become subject to Workman's Compensation laws of California" CIARENCE'S SEPTIC & SEWER SERVICE <br /> 263 So. Oro 4 Stockton, Calif. 95205 <br /> Signed ......_.. .. . . ......................... Owner 4 3.320 Contractor's Cic,#267177, <br /> By ... ,:t . ..7 `... `........................:. title ;x ................... . ..... .. . <br /> f other than owner} , <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY <br /> ............................................ DATE ................ <br /> BUILDING PERMIT ISSUED <br /> ....................................... ..................................._.........................DATE ........................................... <br /> ADDITIONAL COMMENTS .............. ...............:........................... <br /> ................................... ................................................................................................................... .................................................. <br /> t <br /> Finoi inspection by <br /> ...::.. :::::::::..:::::::::: :.:..::.::::::::::.::.................oat 3 . ............................ <br /> EH 13 24 1-68 Rev. 5K SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3MM�� <br />