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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) ermit o--------------If------ � -_------------------------------------------------------------ This Permit Expires 1 Year From Date Issued 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. JOB ADDRESS/LOCATI N Z/ 7,---- ---- H-i4/�Ifs6S4RA CT. ---q-------------------------- Owner's Name.--------- (-1-4/--------061- 1e)eA------------------------------ ---- ----- --- -------------Phone Address- ...tom- t-- '3 3-�--------------- city-, /`�-A--I�L�"��--------Zip-- --------------------- ------ �-� Contractor's Name- . c(.�-�- _�-_� __,4& -„--License # - - 1.- -_Phone_-2�, �.0�_ Installation will serve: Residence ❑ ' Apartment House ❑ Commercial ❑ Trailer 6WAO Motel ❑ Other-------- --------------------------.--------- - 5&61N -_ umber of living units:..... . .......Number ofb drooms__- ....Garbo a Grinder-.`-� Lot Size. - - - -----C ' Water Supply: Public System and nam --- ---- � . -Private ------------ Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam X 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 _ Q , [ 1 SEPTIC � ... Size--- Depth.-�.------------------N Capacit} oG� ,�,TYpe_ lL -GlMaterial_ No. Compartments-____.a2.:.--..__-___._ . _ Distance to nearest: Well- AS -0 -._-----------------Foundation--Ar-�---- Prop. Line------�--.r � ' v LEACHING LINE j' No. of Lines--..--- Length o each line g ----------- --- Total Len th -- - ---��------- 'D' Box--/-- -Type Filter Material- - - ...Depth Filter Material-_- \ Distance to nearest: WeiI -I-�-a.f_-.-.--Foundation___1�_--___-__----Property Line------4------ _--./_.-- ---_---.----. SEEPAGE PIT [ ] Depth----- ------Diameter--------------------Number-----_--.-.---.---------------- Rock Filled Yes E] No WaterTable Depth---------------------------------------------------------Rock Size----- ------------------------------------------ Distance to nearest: Well..---------. -------- --------------------Foundation--_--------.------------ Prop. Line-.-----.------------- .---- REPAIR/ADDITION (Prev. Sanitation Permit#----------------------------------------- ------Date---------------------------------------------_) SepticTank (Specify Requirements)--------------- ---- -------------------------------------------------------- --------- ---------------------------------------------------------------- Disposal Field (Specify Requirements)-----------_-------- ---------------- ---------------------- ----------------- .------------------------ -- ------------------------- ------ --- ------- -- - ---- (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 Coun Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents signature certifies the following: "I certify that in the performance of the work for which this permit its issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." CLAR1rhCE'S SEPTIC & SEWER SERUIC$ Signed----- ----------------- - Owner 263 So. caro 1:, Sfc.a tt..i, Calif. 95205 Bv------------ - ---Title..............Ph,siL&S201a----CGJ]3rZCIii..c-i (If other than owner)V F9JR DE TME T USE ON;Y APPLICATION ACCEPTEDBY ------- -- ,. -------------DATE. 7~J _)e----------------- DIVISIONOF LAND NUMBER---------------- -- --------------------------------------------------- --------------DATE ------------ --------------------------------- ADDITIONALCOMMENTS--- - ---- ------------------------------------------------------------------------------------------ ------- -------------------------------------------------------------------------------------------------- -------------------------- ---- -------- ------ FinalInspection by- ---------------------------- - ----- ---------------------------------------------------------------- ---Date -------- ------ --------------------- ---- EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F85 21677 REV. 7/76 3M