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FOR OFFICE USE: FOR OFFICE USE: T� APPLICATION FOR SANITATION PERMIT � Permit No.�=�� (Complete in Triplicate) __V------------ - ----- -- - --------- - --- Date Issued__ --------------------------------- This Permit Expires 1 Year From Date-issued I 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 complionce with Count Ordinance No. 549 and existing Rules and Regulations: 1 ESS/LOCATION.-- .JOB ADDR --- ----- -------- .-.__.CENSUS TRACT-------------=-------- Owner's Name n ------------- - ' #. -- P one------------------------- ------- --- City_ -Zip- Address--------- r( 'u-.-- Ci Contractor's Name--' r' `� -_License #. - .1-/_ -Phone_ f InstalIation:wiII ,� 1 ' serve: ` Residence {, Apartment House ❑ Commercial ❑ Trailer Co.�rt ❑ t ------ ' r . . _ otel ❑ Other------_------------------------------------ s �y � Number of.living units:____- -_-Number of be room _ _ Garbage cinder__' ---Lot Size______<. ..----------- -------------------------- s ivat ' Water Supply: Public System and'name 9: - ----------- ------ C4. /!_: = ------ ------.--:,-Pr' T e . � Character of soil to a depth of 3 feet: Sand I] _Silt❑ Clay ❑ Peat 0 Sandy Loam ❑ Clay Loom ❑ �� 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.) SEPTICank:or seepage 1 ft :pe rr'tte f public sewer is available within 200 feet,] ! NEW INSTALLATION.- {No se tic tTANK` ["'] j��:S' ie---- ----------------- ---- -------------------- Liquid Depth: ---'- PACKAGE TREATMENT—[,]"� i .. _ TYpe F= Material mpartments ----------- ------------- Capacity - l E . ,Distance.to nearest: Well '_.------- ---- Foun ion - r-----�-:�Pr p Line---'-- �._. ..�� it E 11 LEACHING. LINE_ [ No. of Lines-'-___: ___.,_•.-__ - Len_g'th o each line.___-__ _, total Length.__--- -___ a- /- 1. • D' Box-_' __Type Filter Material_- - `Depth Filter:;MaterlaL_:.__ _ ____ __ ________ e .Distance to nearest: Well_:_ _� _ � f --=-- Pro er Line.--- �__--- Foundation___ t p ty �r SEEPAGE PIT pep thaG- .....Diameter__ •d�___' Number____ ] Rock Filled YesA11 No❑ t Water Table Depth ------------:-----------------=-:---Rock Size_ -- -- ------------------- - _._. Distance`to neprest: WeIL_- L --'-----'Foundation=_ Cl-' Prop. Line.___ - l a � k . REPAIR/ADDITION (frev. Sanitation Permit#--- -------------------- ----- -----------=---- -Date--------- - Septic Tank (SpecifyERequirements)------- - -------- -:-- ---- - ------ ; - - f C` f : r • Disposal Field(Specify Requirements)_' ---- - --- ---- - I-- ------- --=-- ./�`'�`.`-------------------TI--------....... �- -- --- -- - ---- -- ----------•------ ------ -------------- ----------- 1 -----------o- ------------------------ - -------------------- -----i;-----------i - ------------ - --------- --- - - (Draw existing and required adddition on reverse'1side) �. Q I hereby certify thatil have prepared,this application and that the work will be done in accordance month San Joaquin County Ordinances, State Laws; and Rules•and Regulations of the San Joaquin Local Health7District.._Home�owner or licensed agents signature certifies the following: "I certify that in the perfoi ante of the work for which this permit is issued', I shall not employ any person�in such mannerras to become subject to-Workman's Compensation laws of California. CLARENCE'S SEPTIC & SEWER~-SERVICE l ; Signed_- -----------------------1. - 63 Soc ro F Owner „•,� 2 � Stockton, Calif. ^95205 i _ _ r ---- --- --- Contra r's` Ph.463.3209 - cto -__L_ic_.#2fi711------_ (If'other than owner OR'DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- - :- _ - - ----- --------------- ------------------- ---DATE _ ''. DIVISIONOF LAND NUMBE - ----- - =------ ------------------=-------- ------------ -- ----- ----------DATE '---------------------- --- ----------------- ADDITIAL COMMENT --- -- ------ -- -------------------------------------------------------------=----------- --------------------------------------------- ------------------------- --------------------------------- ----------------------- --------------- - ------ - --- --- - = ------------------------------------------------------------ X/ ---, - - ---•--------- ------------------------- --------------------------------------------------------------------------------------------------- _-Date Inspection by:=- -- -----.�. ,, r... _._. ,.._ '------ ------------- Date - -,�-�_ ------ -- ---- --- - ---------- EH 13 24 , / AN JOAQUIN LOCAL HEALTH DISTRICT F&s 21h" �'a inn J