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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----------------------------------------------------- Permit No.�_ _'_; 3_Js (Complete in Triplicate) ----------------- ---- - ----------------------- Date Issued,3 �.� - ---- 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 N . 549 and existing Rules and Regulations: 7 ., r /Zl�' CENSUS TRACT -------- ------------ -------- JOB ADDRESS/LOCAT 1/-_ __ _ _ ______ _ ___ F____ _____ _�___ Owner's Name----- - // --- ---- -W----------Phone--.----- Address--------- ----- - - l -/ ------ - - itY- ------------- -----------Zip -- Contractor's Name�' .�-_�� -, _,Qe.� � r �` License 1_ _Phone_ 9.2G� Installation will serve: Residence Apartment House.❑ Commercial ❑ Trailer Court ❑ ,r Motel ❑ Other--------------------------- - ----------- Number of living units:---!___--------Number of b r000ms___`?.__Garbage Grinder-701-Lot Size----!AP---4_____ ________ ---------------- 10, Water Supply: Public System and name A- t _J K.._---A-�✓� - - Private Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ HardpaXAdobe ❑ 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 er it 'f public sey;er is available within 200 feet,) J- PACKAGE TREATMENT [ ] SEPTIC TANK [ � ize----------------------------------.------------------------Liquid Depth -------------------------- & Capacity---------------------Type-----------------------Material----------------- _-------No. Compartments-------------------- ------------ L4 Distance to nearest: Well--------------------------------------------Fo�3`'J ' t'i`on�--------------------------Prop. Line--------------------------- 7V LINE No. of Lines__--__.-Z__-_____-__.Length of each line.___. _______________--Total Length.._{--�Q-_____.._--_._-----__ 'D' Box----/-----Type Filter Material_ ----Depth Filter Material-----/ ------------------------- Distance ---------------------- Distance to nearest: Well--- - --- --- .------Foundation------- _ ______________Property Line----- SEEPAGE PIT ( Depth_{ —Diameter_._�17__^__(.Number-----vZ________-__--�__-__� Rock Filled Yes 2k No❑ Water Table Depth.__ic ---a'-------------------------------------------Rock Size-----/--- - - - - --------------- Distance to nearest: Well_____ _________________Foundation----- _`:.____.Prop. Line---y _________---------- . REPAIR/ADDITION (Prev. Sanitation Permit#___- ----------------------------Date-'- ----------------------- ----------------- Septic ---- -Septic Tank (Specify Requirements)--------------------------------------- --------- ---------- --------- --- ---- -------------- Disposal Field(Specify Requirements _ - JrZ. ' -or "^' "`� 41 ---------------- - - ---- ----- ----- g'------- ------------------ --------------------------------------------- Com— . -------------------- ------------------------------------- -------------------------------=------------------------------------------------------------------------- ----------------------------------------------- - (Draw existing a9d required addition on reverse side)- 1 hereby certify that I hove-prepared: application and-that the work will be "ne in accordance with Son Joaquin County Ordinances, State Laws, and Rules` and Regulations of the Scno Joaquin Locat Mealth District. Home owner or licensed agents signature certifies the following: "I certify that in the performance of Imp- -.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." Signed_-__. __ WRENCE'S SEPTIC & SEWER- SERVICE - n 263 So. Oro � Stockton, Calif. 95205 -- -- . -._--.Title- -----------Rf1:-G =32{�� Ct�nTractor'stic: 677� (If other than ner) FOR.DEPAIi`TMENT USE ONLY - 77 APPLICATION ACCEPTED B � - -- - DATE-- -------- � ------------------- - _ ___ DATE DIVISION OF LAND NUMBER.___ _______.----------------------------------- ___________ ____ _ -"� ADDITIONALCOMMENTS----------------------------- ------ - =-----------------------=--------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------- -------------------------------- ------------ -- - -- --- -- ------------ ---- - - Final Inspection by --- - x -- --- E3ate `III 4 EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/76 3M