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-F,QR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No----------------------- -------------------- This Pgrmit Expires 1 Year From Date Issued 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 and Regulations: JOB ADDRESS/LOCATIO ----- --------- ---------------------------------------CENSUS TRACT---------------------------- Owner's Name--------- --------------------------- ----Phone--- Address--------------------- --------- --f--------- --- ----------------------- ----------------City- -- -----?--------------Zip------------------------------ Contractor's Name- _ __ -__ - �r �.. _'License #Z_�__ rY 1-----Phone---------------------------------- Installation-will carve-:------ =Restdente --Aptn-tmetst House❑ Commercial-n Trailer Court ❑ fA—otel ❑ Other-------------------------- Number __ -- -Number of living units:_ /____ ._Number of b_e roam _a Garbage Gr' der_--�" _Lot Size . � _ ------------------------- Water _. ` �. - - - ---------- Water Supply: Public System and name ___. ___ -_t�tl� _______ __. _Private ❑ ------------------------------------------------------- Character of soil'to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Fill Material------------ yes,type______________________________ 1 (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 rsseeepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ) SEPTIC TANK Size`__ __ __________________________Liquid Depth_ ____-._____.______ Capacity/.l.0_C,44-Type_;0044c _Material_-C��•_�.C�f4t No. Compartments------,7..----- Distance to nearest: WeIL__ __ ------Foundation ------__-________Prop. Line---7!4�-_-_____________ LEACHING LINE::�A No. of Lines----.__-------------------Length of each line.__-__{-11-01_ g le ----------------------- _ _.___Total Length D' Box_ __Type Filter Material_--- _D pth Fitter MateriaL.___�_� A -- -- --- --- ---- - -- -- --- Distance to nearest: Well___ _Aal -Foundation__/0_ ____________Property Line__-__`._______-..__--__. Of SEEPAGE PIT [ Depth�$`_�__Diameter__J-C---�_Number-_- _____/-_______._-______ Rock Filled Yes ' No E]9 Water Table Depth____._. _ -------Rock Size___ _l -- --------------------------------- Distance to nearest: Well__-_- __-_;......Foundation----- 67__P_______.Prop. Line___ 1 -------------- REPAIR/ADDITION (Priv. Sanitation Permit#__-______--_________ .__�______.________________:_ ) ---- Septic Tank (Sp+erdy Requirements)--------------------- - -- ---- -- - --- Disposal Field 4pecify Rep�irements)__. _______ ________ _ F_--__Y ___-__- -___:--- _ // --------------------- - --- ---- - ------ --- ---------------- t ------------------------- ---------------------------------------------------------------------------------------------------------------------- -- -------- (Draw existing and required addition on reverse side) 1 hereby certify Omt-I have-prepared this-application and-•the*-the •work--will be done`,in accordance with San 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 & SEWER SERVICE Signed - -- - ----_Owner 263 So. Oro � Stockton, Calif. 95205 By- --- --- ------Title- ---Ph.463-3209L----Contractor'S-Lic.#-267-1-7.Z------ (If other tl 6;, ...�. #OR RTMENT-USE ONLY APPLICATION ACCEPTED BY---------- ----------------------------------------------------DATE.----- 1� 3- DIVISION OF LAND NUMBER ------------- --------- ------------ DATE - - - ADDITIONAL COMMENTS_____ J j-- Q_ - -= -------------------------------- -- - -__. ---- - ----- ----- ----- ----- --- ---- -----------__-,--------- - ----------- ---- ------- -- Final..inspeetron - .� -t - -_ _ EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&s 21677 REV. 7/76 3M