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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .q --------------------------------- ---------- - Permit No.7�77 (Complete in_IriplkvW ------- ---- ------- -------- ------------ • Date Issued. _.___._..________.__-__.___._-___-.-_ 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 Coun -Ordinance No,. 549 and existing Roles and Regulations: JOB ADDRESS/LOCATI N L l 1J 11------ -- -- -- ------ --- -- -- �NSUS TRACT------------------------------- Owner's Name---- --J - ---------- -------------------------------------------------------- ----- Phone----------------- -------------------- Address--- C3 l3 I ��.Clt � i+C�y ---- ` -- City - -G�-�re.��y Zip Contractor's Name . q ;; " -,license #_ /1 ��' Phone ' Installation will serve: Residence Apartment House.❑ Commercial ❑ Trailer Court [IM tel ❑ Other - ---------------------------------- Number of living units:--- Number of b drooms------ -----Garbage Grinder,--4E5`__ Size-------�---- ----------------------- _ Water Supply: Public System and name------ -- n ---------------------------------.-------------------------------Private Character of soil to a depth of 3 feet: Sand ❑ Silt;❑ ,Clay ❑ Peat Q Sandy Loam Clay Loam ❑ �wC' Hardpan ❑ Adobes fill M4*-Aal :---- ----If yes, toe-------------------------------- (Plot ----- -- ----- ----------- (Plot plan, showing size of lot, location of_sXstem in relation towells build ings,:etc. must be placed on reverse side.) NEW INSTALLATION: (No;septic tank or seepage pit- permitted itpubhc se+er is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTICTANK Size....4� r� _�.----------------Liquid Depth. __S- -- ___.-_-___ Capes ZOOG`� t�(L Type Material-_ i?G^tiC�+atit No. Compartments 4' r.... . Distance to nearest: Well.-4V- _ ---------------------Foundation .. ----Prop Line_. � LEACHING LINE,,' . No. of Lines-._-_-4=17 ______ Length each line -f __Total Leth , � ,�' f ------�� y D' Box __:_Type Filter Material__ --------------Depth filter Material_____1 .___... . _.__-. Dist�lnce,to c Well_ -r x:_____-Foundation___.` 7 -------Property, Line ._-- ------ _. ______-_--. 01 p De th__ Diameter_-.--_ -- -- . ._.__ Rock Filled (Yes No ❑ e - Waterjoble Depth__ -:-- - ----- --------------------Rock Size.----- ----------------------------------- Distance to nearest:Well4___ ------------Foundation-_-_f --__QC__.Prop, -Line.. -_ _-�)___.... REPAIR/ADDITION (Prev. Sanitation Permit#---------------------------------------------------q6te------ --- __-.__ ___---.-- ------Septic Tank (Specify Requ wrr.►ents)--.. Disposal Field (Specify Requirements)-------- ----------- -------------- -------------------------------------------------------------------------------------------------------- N --------------- - ----- ------ --- - - -------------------------------------------- --- -------- - - ------------------------------------------------ - --------- ---- (Draw existing and required adcTitionbn 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 ,a dtRegulations of the San Joaquin Local,i#ealth District, Home owner or licensed agents signature certifies the following: "I certify thaf 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." Signed---- --- ------------ --_`' ------------ ;-- -------- -------------Owner CIARENCE'S SEPTIC & SEWER SERVICE ----- __Title_ ___. 263 So. Oro 4 Stockton,_Calif.._95205i__.____- BY an ------ - (If other than owne Ph.46 -3209 Contractor's Lic.#26717A FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - ---------------DATE. - - DIVISIONOF LAND NUMBER-.-------------------------------------------- ----------------------------------- DATE-------=----------------------------------- ADDITIONALCOMMENTS---------------- --------------------------------------------------------------------- -----------------------------------------•-- -------------------------------- - --------------------------------------------------------- ------------- - � _ _ a� -- -- ---- - - ---- --- -- - - - --- -- --- -- -- Final Ins ection b - - - Date �'3' p y. _-_. --- ►. EH 13 24 SAN-JOAQUJN LOCAL HEALTB QJ,$ .. CT. .- F&S 21677 REV. 7176 3M