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FOR OFFICE'USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �� d ------------------------------------- - ------------ {Complete in _.. Tp irate Permit No---- ---------------- -------------------------- --------- o.------------------------------------------------------- Date Issued----- ------------ _-------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San oaq`uin Loca! He_alfh Distr`iq for a permi"t to"con'struct ani install the work herein described. i p is made?Jnco li 'th County Ordinance No11549 and existing Rules and Regulations: fJOB A D e/LOCATI t - 11 ,1 Stf RACTOwner's.Name- ------ - - V--------- fA----- ----------- -- � ------------Phone-a.. Address--- c 1 •- �i---- ---------�r----AIGr CA--F/U.4--City...IlfA A/*re.CA--------Zip---------- ----- -------- Contractor's Name _$-_ V2 --.C.� `t-.z 4.,A, License #,se� _ -f"t--Phone -- . Installation will serve: Residence ❑' Apartment House.❑ Commercial ❑ Trailer-@W w Motel ❑ Other----------t----------- ----- --------------- ( ��..� Number of living units:-----------Number of b drooms__ _-___Garbage Grinder__`--.Lot Size_C�_ 6------------ -------------- p Water Supply: Public System and name------� , - _ =------- ---------------- -------------------- ----------------------------------Private la\ Character of soil to a depth of 3 feet: Sand E) Silt ElClay ElPeat ❑ Sandy Loam X Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material--.-A------If yes,type __.___---.--_.__ t t (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) F NEW INSTALLATION: (No septic tank (?r seepagepitpermitted if public sewer is available within 200 feet,] PACKAGE TREATMENT { ) SEPTIC TANK Size---Z_e)irl�!_11x Al f------------------Liquid Depth--:4------------ 14/ ' Ca ,cit o. Compartments .---_ t P - } pp Pro Line..__.--r. Distance to nearest-'Well._.`�f --f i_____________Foundation-- ----____-- p. r� , LEACHING LINE No. of L`ines____--1-2 r-- .---_.__ .Length each line.�j ____._____-.Total Length.-. _.___ i," f D' Box-V__. ---Type Filter Materii'.i'�_ t'�`°___.Depth Filter Material-----1-09��--------------------------------I.------... "" / Distance to nearest: Well-/Z ---____.-Foundation___ �._f----------Property Line----- -__.____________.______ SEEPAGE PIT [ ] Depth_-. ------------Diameter..------1-----------Number-------------------------------- Rock Filled Yes ❑ No❑ WaterTdHi -Depth'---------- 5----------------------------------------Rock Size--------- -------------------------------------- Distance to nearest Well___________________ _- ------Foundation--------------- ----------Prop. Line.---------------------- REPAIR/ADDITION (Prev. Sanitation Permit#--G-------------------------------------------------Date-------.--------------------------------------) Septic Tank (Specify Requirements)-----------4 -------------------------- -------#--------------------- --------------------------- -- -------------------------------------- Disposal Field (Specify Requirements)-- ----------- _._ ' I i ----------- ---------------------------------------- ---------------------------------- --------- ------------ --------------------- �. ------------------ ------------------ t -------- - `.------------- ----------------------- -------_"`�- ---^---=-�----_'-"`----�-"=was'-------- ---------- ---------------- - + ; (Draw`4 xisting and required'crcldition on reverse side),: I hereby certify that, have prepared thisapplication and that the {work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regu!at Ms of the San Joaquin Local Health District, Home owner or licensed agents signature certifies the following: r s t "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 becomesubject to Workman's Compensation laws of California." Signed___r--_- )Owner CLARENCE'S SEPTIC 8, SEWER SERVICS -- - 203 Sc. Oro 1� Stockton, Calif. 95205 BY-------- -- ' ----, .�� s Title_ {�It:4Ci�=32f39 Go-r�itae i�r=safe. ,�20� 7_ (If other than owner) j FO EPA ME T U E ONLY ! APPLICATION ACCEPTED BY ----Claw_ - `--- ---- ------------ ---------------DATE---- .-�. a`---, ------------------ --- --- ---- ----- ----------- - DIVISION OF LAND NUMBER--------- -------- ------------------ ------- DATE-------- - --------------------------------- - ----------- i ADDITIONAL COMMENTS---------------------- ----------------------------------------------------------------------------------------------------------- ------------ i --- ----------------- -------- ----------- ---------------------- ------------------ ------------------------------ Fina] Inspection by _ r �. 4 } ----g �r a�-Dat, ----- . F&S 21677 REV. 7/76 3M EH 13 24 Y �� SAN JOAQUIN LOCAL HEALTH DISTRICT