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FOR OFFICE USE: . FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 1 % Permit No.?.g--2-3 (Complete in Triplicate) ---------------------•----------------------------- ' � Date Issued__3-_�.g".? 1 ------- ------ 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 No. 549 and existing Rules and Regulations: Y i JOB ADDRESS/LOCATIO -- . - -- -0 ;` I�✓ l /�G ENSUS TRACT Owner's Name-. .}--- - -- - --- ------ -- --- --- --- C�C-pt:C�--------------------------------. -------.Phone Address--..-----. �f ------- 4i --- -------------------City Zip ----- - contractor's -- contractor's Nam ------- -- ..- ... -- - _ - r �. i License #."e .�a_ 1.��'Phone_, ,� .-2a ---- Apartment House.❑ Commercial ❑ Trailer Court [Ilnstallation will serve: Residence Motel ❑ Other---------- ----------------------------------- Number ---- -------Number of living units:___-" ------Number of b rooms__ .Garbage Grinder_°-tq--Lot Size---4-e-Y -- ----"" i� -----------------------------------------_- - ----- Private ' Water Supply: Public System and name, _.__".."" 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,) � ` -------------------- .� PACKAGE TREATMENT [ SEPTIC TANK [ Siz -__�_ -_ "�"_"._ _ "--"_""- Liquid Depth_.-----------------"___% Capacitylg�C�L-TYPe.- f --- aterial----- ------ --- --- - o. Compartments • Distance to nears __--Pro Line___ ---,Length of each� a ""Foundation_- ___- LEACHING LINE; No�of„Lines "__ "W " fig o line._._-�.Gt_Q. ---------Total Length ---------------I )+ tD' Box--"l Type Filter.Material "_� =-_Depth Filter Material-- -- ------------------- ________ -, . ,. .. FE.4` �# ! Distance to nearest: Well'_ a -- -------------Foundation_^l4_------.---_____Property Line... _----_---- SEEPAGE PITS �[ y a£ p - ( i Rock Filled Yes Noy 4 De th Diameter. -----Number- ----- -----�---=------- ❑ ❑1 j Water Table Depth.---------------------- -------------------- ---- ----Rock Size---- ------------ ------------------------------ " 'Distance to n-`ears '1Nel'I.'"` .,.----` Foundation ------ `-----.Prop. Line----------------- -----=-----T1+.. _�.,.�..� ..� REPAIR/ADDITION (Prev. Sanitation Permit#-------•------------------------------- --r=="_. ate---------- -- 1 O' Septic Tank (Specify Requirements).""-"" �- } ---- Disposal Field (Specify Requirements)-- --------- - -------------------- � � -- - i ,Z.; ------------------------------------ - --------------- --------- -------- ----------------- -------------- ---------------------=------------------------------- ---------- ------------------ ----- --- ---------------------- ;- ----1--;� F (Draw existing and required addition on reverse side) ' I 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 LoC61 Health District. Home owner or licensed agents signature certifies the following: j �v "I certify that in the performance of the work for which this permit is issued,11 shall'not employ any person in such manner as to become subject to Wor'kman's Compensation .laws of California." t p*' •. A i '-� CLARENd'S SEf 71C` SEVIER SERVICE ' i Signed t =---------------- -- ---------------- Owner 263 So. Grot_ix S k on, Galif. 95205- C 5205^' t BY ' = ------Title--- - ---- P_h.:9G3-3209 Ccrtrac r°s Ltc._#2671.aI {1f other'tF n�owner) F i} FOR DEPARTMENT-USE ONLY APPLICATION ACCEPTED BY -------------=-------- = DA DIVISION OF LAND NUMBER ----------- --- - ------------------- - ------------------------------------------------ . L ? -------- ---' -- -`- . . r ---- -------.ADQITIONAL COMMENTS 17 ---------------- r = .------------------ ----- ' = r GY,Th..�" ar f e'--! �I�----- - ------ ----- --- - i -. �. X ----- ------- --- Final Inspection by:. ------- ----'----- -- ---- ----------- -- --- -- -3-24 - SAN-JOAQUIN-LOCAL-HEALTH-DISTRICT