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voc APPLICATION FOR SANITATION PERMIT { <br /> ,. . . ..{................................... )Complete In Triplicate! Permit No. ..?.7R <br /> ...........I.......................... This Permit Expires 1 Year From Date Issued Date Issued ................... <br /> Application Is hereby made to the San Joaquin local Health District for a permit to constrict and install the work herein <br /> described. This application Is made In compliance withCountyOrdinance No. 549 and existing Rules and Regutatlonss <br /> .LOB ADDRESS/LOCATIO 1-/..,�� ......... r..... .�,."e ..............................CENSUS TRACT .......................... <br /> Owner's Name ........ . . .. ......... t...................... .Phone .................................... <br /> Address .......pT.1. ......... ._.1........oeo..-•----••.............................rciN ....................................... <br /> Contractor's Name .;; �.t :.... &.c..,r............License a.Mfl` )Phone! cry. <br /> Installation will serve: Residencep( partraent-House E]Commercial❑Trailer Court ❑ <br /> Motel❑Other............................................ <br /> Number of living units:...---_-•-.. Number of room: ... . ._...Garbage .... Lot Size .. _.....X.��.�.......... <br /> Water Supply, Public System and name ..... .......... ! .�.....!-���.-............................................Private ❑ <br /> Character of soil to a depth of 3 Teets Sand 0 Silt❑ Clay ❑ Peat❑ Sandy loam❑ Clay Loam❑ <br /> Hardpan❑ Adobe Fill Materlal ............If yes,type............... ............ <br /> (Plot plan, showing size of lot, location-of system in relation to wells, buildings, etc. must be placed on reverse side. <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted Jf public sewer Is available within 200 feet,) <br /> PACKAGE TREATMENT [ SEPTIC TANK �S'�` -... ...................................... Liquid Depths..:r...--......... <br /> Capacity .................... Type ........:.......... Material...................... No. Compartments ...................... <br /> Distance to nearest, Well' ....................................Foundation ......... Prop. line . <br /> Tota! Lan eh <br /> LEACHING LINE No. of lines ........................ Length of act line...._. .. . .......... -- :............... . <br /> 'D• Box ._./...�Type-Filter Material �, ..0 .....Depth Filter aterial ... .................................. <br /> Distance to nearesh Well `��. Foundation .... ...... Property ......... <br /> SEEPAGE PIT ; <br /> f <br /> DeptiyS;�'`:-_.. fliameta� :....... Number ._., ........ .... Rock Filled Yes No <br /> Water Table Depth ..--•---.,-5R7 ..................... <br /> e ........... ............. -. <br /> p .. .--•- -Rock Size .�. <br /> 4 <br /> Distance to nearest: Well 97.12.. 11..1 ......Fooundation ..../ ... Prop. 'Line ................. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..................................I <br /> SepticTank (Specify-Requirements) ........................................................................................................_............._................ <br /> DisposalField (Specify Requirements) ..................................._................................................................................................. <br /> .................................................I....... ...........................:,a .... • a..................................................... <br /> .._ - (Draw,existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done In accordance with Sen Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any persons In such manner <br /> as to become subject to Workman's Compensation laws of California." CLARENCE'S SEPTIC & SEWER SERVICE: <br /> Signed ............. .. Owner 263 So. Oro -�L Stoc�ton, Calif. 95205 <br /> Ph.463-3209 Contractor's Lic.1267,lZ74 <br /> sy ...... _ .- � - Sitle .... I .. '.......................... <br /> (If other than owner <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-7,7 --4!J -(.......- .....................7............................. DATE <br /> BUILDINGPERMIT ISSUED ............................. ................-•----..............................................DATE ...--•--•.................................. <br /> ADDITIONAL COMMENTS ................................................................ <br /> ..... <br /> ............. <br /> .... <br /> ... <br /> ..... <br /> ........ <br /> .......... <br /> ................. <br /> ..............-.......... <br /> .....................................................• -------•--•-----............. . ---. ��- -•------........-........_.......................----.. —..............-... <br /> ................... ::::: ::: .--......... .-..: : ::: ::.: � :: -...:::::::::: :::::::: .............. <br /> . .-......................................... <br /> ...Final Inspection by. 1 ... .. ............ <br /> r'" ......---.......-.............-.Oeste .. ..... .......... <br /> Mi 13 24 1-68 lila,• gN SAN JOAQUIN LOCAL. HEALTH DISTRICT 8/7h 3M <br />