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FOR OFFICE`USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT D r� <br /> (� Permit No.-- --7 / <br /> (Complete Triplicate) <br /> -----2--�---------------- - ' ' <br /> ); Date Issued- __54_ <br /> -�,27 <br /> This Permit Expires 1 Year From Date Issued <br /> S <br /> Application is hereby.made to the San Joaquin Local HealthljDistrict for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> ADDRESS/LOCATIQII ,• � - ---__ fi ^` j_ -`� -�� - -----CENSUS,TRACT ------------------ <br /> JOB r <br /> Owner's Name---- 7 , �€ � Phone <br /> Address44 J <br /> ", r - ` !�' City ems', ZAP <br /> Contractor's Name _-_-_ License #- . _ `_ __ ___Phone __ __ <br /> Instal lation.wilI serve: Residence Apartment House ❑ Commercial ❑- _Trailer Court ❑ <br /> Motel ❑ Other f_ r <br /> --- <br /> Number of,living unitsr-_ Number=of bedrooms �'_:, Garbage Grinder_ ` ='_Lott Size_ �-----_ ' <br /> Water Supply: Public System andrn me = r�sem' " _______ { __ ___,___ _____ ________Private <br /> Character of soil to a depth of 3 feet: Sand ❑ t­ Silt❑ _'Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe Fill Material_-._ Jf yes, type ______ -------- <br /> 4— <br /> (Plot <br /> __- _(Plot plan, showing size of lot, location of system in relation to"wells, build-ings,:etc. must be placed on reverse side.) <br /> NEW INSTALLATION:• (No septic tank or seepage pit permitt�c� i -public sewer is available�Yvithin 200 feet,) <br /> PACKAGE TREATMENT [ ) ="SEPTIC TANK 'O � i __ - ) i >s____Liquid Depth_.-------------------------- <br /> --------- <br /> ______ __________ <br /> TY..pe = °__MateriFal ---- -_ t_No.�Compartments----------------------------------- <br /> capacity' s r <br /> Distance to nearest: Well - __ ___ Foundation t Prop Line----------------- <br /> {, T !`^mss I <br /> W. <br /> LEACHING LINE' _No. of Lines,'_ __ �t ;_ . Length.of ea h line � az�� __ Total Length __�v '_- _ <br /> D' Box ---'.--Type E. ___.-Depth -Material b ®� ` <br /> __ T e Filter Material_ .__ __ <br /> 3 p. Distance to nearest: Well _-_Foundatk n:_� ____ w _ Pr'operty Line-- <br /> Distance I <br /> 3 <br /> SEEPAGE PIT Deptl �l - I_ __Diameter Number Rock Filled Yes ' No <br /> t Water Table;Depth__ i,C Rock Size '_ - ----- _ _ ____ _ t <br /> # , <br /> l ✓� <br /> Distance to nearest: Well_- W -Foundation '_ Prop. Line_ ______ _ i <br /> REPAIR/ADDITION (Prev:Sanitation Permit#_. = Zate -------------------------- <br /> Septic <br /> — '""`Septic Tank .(Specify Requirements)_ s -=- - _ " ` --- <br /> ------------------------------------ <br /> - <br /> �'' - -- ---- <br /> r - f <br /> Disposal Field(Specify Requirements) ` -: ---------------------- <br /> --------- <br /> ___- _. - <br /> ----- - ------ ---- --- n ------ ---------- - ------- ------ ------ ------- -------- <br /> ---------------------------------------- <br /> _ - <br /> ---- - ----- ----- ----------------------------------------------------------------- _,�--`a -- <br /> (Draw existing arid'required additiomon reverse side) <br /> 1 hereby certify that;I have prepared thissappiicatiomand.that,the�work .will-be-done_i.n_.�accordance with San Joaquin County I <br /> Ordinances, State Laws? and Rules and Regulations of the San Joaquin Local Health District. Home owner or. licensed.agents <br /> r r - <br /> signature certifies the following q ' <br /> "I certify that in the performance of'the work for which this permit is'issued;;l shall not employ any person in.such manner-as <br /> to become subject to Workman's Compensation laws of California." ~. .'.. , <br /> Owner '• CLARENCE'S SEPTIC & SEWER SERVICE <br /> Signed ' "- --- - i <br /> 2 <br /> l� 63 So. Oro x�'.Stocicton`t Calif.' 95205 <br /> BY i - Title :- Contractor's Lic..#267I7�3 <br /> JV <br /> Ah 463=3209 <br /> ( (If other than owner) ( I <br /> : � F <br /> ' - <br /> FOR.DEPARTMENT-USE-ON Y, <br /> APPLICATION ACCEPTED BY,:-- ---- ---------- <br /> --------------------------------------------- - _DATE, -------1 -- --------- <br /> DIVISION Of LAND NUMBE ._ '�" ` ' .............. ______--- _______ ___-__ : <br /> -= - --- -- --- <br /> ADDITIONAL COMMENTS ffi t :- ---- ----- --- -- --------- <br /> )- ------------------------------------------------- <br /> I <br /> --- ------- ----- -- <br /> --------------------------------------------- •-----_----_--- --- - - -- ----- <br /> --- l <br /> Final-bnspectron-by. . - "'gate_ . --- , -- .-1� <br /> EH 13 24 - _ SAN JOAQUIN LOCAL HEALTH DISTRICT F&s 21677 6 inn <br />