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FOR OFFICE USE: st. FOR OFFICE USE: APPLICATION FOR.,SANITATION PERMIT i Permit No.- e in Triplicate) -- (Complete ------------------ --------- - - Date Issued -.3' - ,� �__________ _-----_-_-_-___°� _.___.__ This Permit Expiresil ,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 No. 549 and existing Rules and Regulations: a --------- "TRACT " -- - ------ CENSUS JOB ADDRESS/tOCQTI N01 3 r Owner's Name-------- - -- - ----- ------ - - Ph - - - one Ad1dress a/ City-- Zip p � Contractor's Name_S, d.� _ ®License #__ -A. �- -Phonee -��'. Installation will serve: Residence Apartment House❑ Commercial ❑ Trailer Court; ❑ ? t Motel ❑ Other - --- -- - ------------- Number ---- t i Number.of living units: ._ _ ____-NumbeA�of rooms Garbage Grinder__` '_Lot Size.__ _ - -- �- ---- _ Private ❑Water Supply: Public System andlnameh- - - Character of soil to a depth of 3,ffeet� Sand Silt❑ Clay ❑ ° Peat❑ Sandy Loam ❑ Clay Loam ❑ r s Hardpan [] : Adobe Fill Material_.._ _____ f yes, type________ (Plot plan, showing size of lot location of,system in relation to'wells, buildings, etc. must bejplaced on reverse side.) NEW INSTALLATION: (No septic tank or seepage �i�ermii e� guk is sewer is available withiL120�fDepth) _-------------------------- t _________ ' PACKAGE TREATMENT [ ] SEPTIC TANK [.] 5efze--✓------ ------ q Capacity - ___ Type-- -- p --Material No. Compartments 6 Distance€to nearest:.Welln -s t._: 3s__- __Foundatlon�_ ___ Prop Line_. ®____ -- } e 9 LEACHING LINE' 'No. of Lines_' l_-_�' "___ Length o .each line ___. Total Length ® De th Filter aterial___-_ { 'D' Box /--. Type Filter Plate rial_ _ _ _ --- s r. Property Line Distance to nearest: Well_ i Foundation_'_ ` - - -- SEEPAGE PIT [ ] Depth_ -----------Diameter--------------------qurhber - ----------------- Rock Filled Yes ❑ No ❑ r�'ry Water Tab1,e,:De th__ `_ � �f �° gRock Size= ____ [ ------ -- _-- Distance?to nearest..-Wed �:` .-" ` - Foundation - ____ .Prop. Line__ -- -- __. - REPAIR/ADDITION Prev. Sanitation "'"" a --" .. ate Permit#.; ----------------------------------------- Septic Tank`(Specify.Requirements) ___-' ---- ----- -- -- q--- - - --- I r e`' 1. � f°' t , __ Disposal Field (Specify,Require m nts)_ -- ----------- - - --- - - ---- - - d c r _ __________ -- - --- - ---- -- -- -- _ __ ----- J-,---- --- l : p - f -.___ _ _________ __ ___________ Draw existing�nd..req.uir.ed_add.ition on reverse side) i 1 hereby certify that[I have preps ed this application a;id work will be done in accordance with San Joaquin County Ordinances, State Laws, and R�les and Regulations"of"the San,Joaquin Local Health District. Home owner or licensed agents signature certifies the following: f "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 Workmans Compensation laws of California." { CLAR�ENCE'S SEPTIC & SEVIER SERVIM Signed---- I- ---------------`------ ---------------, -.- ----- -------------Owner 263fSo. Oro Sty kt^n, C� if. �J5205 BY' -��' Title _ 4b -S2'J9. dune�ctor'stic. 26711J7 ` .._ '' h (If other than- ner) " ._ ;., ' ,-- ¢ FOR DEPARTMENT USE ONLY /T, `- ,,r — APPLICATION ACCEPTED BY - ------ ----- _ ------ DATE ------------------------- - - ---- DIVISION OF LAND NUMBER. ------- - DATE ' _ - -- -- ADDITIONAL COMMENTS------ --- --- - --- ----- ------- --------- - - ------- ------- ------------- ------------ ------------------------- ----------- -- ---- - - - - b - �1 ------------- -------------------------- - - --- T --- Final Inspection by:_ - -- — ""-`— - - Date _�� EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fas 21677 REV. 7i7,6 3M