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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------------------------- Permit No._7$'�� (Complete in Triplicate) ----------------- -- - -------- --------------- Date Issued_/D_-!,!,-;�-'7r ..........-------....-----------------------------.------ This Permit Expires 1 Year From 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 o 549 and existing Rules and Regulations: JOB ADDRESS/lOCATI ` ' ----------Ord�inan4ceo 549 TRACT-------------------- ----- Owner's Name - < '--~d_- C �' `` Phone--73_� Y,S_�.Sr--- ------ ---------- - ------ Address-----C-f---� 3------------�-----=-------- '------------City. - -Zip---------------- -- -------- _ Contractor's Name�� 'y ^ _ `�-Phone ,?2 -e'w-`-r License #_- j��f � Installation will serve: Residence Apartment House❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other-------------------- ----- --- r y Number of living units:_--_-/_----Number of be ooms__��Garbage Grincldi'—-----Lot Size------ -_---, Private Water Supply: Public System and name--- ---- -------- ----------------- Vic._t. - -- - - A Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ 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,) (v PACKAGE TREATMENT [ ] SEPTIC TANK [ ] 4t- /I ______---------------------------------------Liquid Depth.__________._.__________ Capacity--------------------TYPe-----------------------Material-------------------------No. Compartments----------------------------------� Distance to nearest: Well---------.----------------------------------Foundation--------------------------Prop. Line------_---_--------__--�S LE=ACHING LINE No. of Lines------1--------------------Length of each line_ /t*/' -_---__--.Total Lengfh.-I_.---------------------------------- 'D' Box------------Type Filter Material--_--- ------------Depth_Filter Material_____________________________ __-_-______--_____------- Distance to nearest: Well------ i`-----------Foiindat(on_- �_. -__ ___...Property Line_._--�--------------------------- 4ol SEEPAGE PIT �(r DeptE��------Diameter-._ _ Number ,� _ _ -------------- Rock Felled Yes No❑ Water Table Depth------ ------- ---- -- - ---Rock Size----oma------------------------------------ Distance to nearest: Well----IV-(rp-------------------------------------------------Foundation-----/0-------------Prop. Line---,S_._----------__-. REPAIR/ADDITION (Prev. Sanitation Permit#_______--__-------------------------------------Date__-_______-_.-----_-- --1 SepticTank (Specify Requirements)----------- ---------------------------- -------------------------------- ---------------------- ---------------------------------------•------------ Disposal Field(Specify Requirements)_ ........... `r t `� ---------- ------------- -� 4s- -- ----' , ,? -------------------------- - - --------------------------------------- - - (Draw existing and required addition on reverse side) 1 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 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.-3209 Contractor's L-- 42G7-17-2- - (If other than ner) R EPART ENT lt5 ONLY APPLICATION ACCEPTED BY------- - - ` "' �- - DATE---------101---PI-7----------------- DIVISIONOF LAND NUMBER.---------- --------------------- ----------- --------------------------------- -------------------DTE---------------------------------- -- ADDITIONALCOMMENTS_-------------- --------------------- -------------------------------------------------------------------------------------------------------------- ------------- - ------- ---- --------- ---- ----------- - - --- _ -- - ---- - ,- ---------- - - - ----- ---- ---- ------ ---------------- --- -- � `t- - - -- - - -- - - ------ Final Inspection by:_ _ Date ��` EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F8s 21677 REV. 7/76 3M