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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT FOR OFFICE USE:7 _�/S <br /> Permit No.--?.4--1-1S- <br /> --------------------- <br /> ------------------- <br /> o--- ------------- <br /> ------------------- --------- ---- = (Complete in Triplicate) <br /> -- ice <br /> , <br /> Date Issued__- -- ----- - <br /> This Permit Expires 1 Year From Date Issued <br /> ---------- ---------------------- <br /> Hd ealth District for a permit to consfiruand,install the work herein describe. <br /> Application is hereby made to the San Joaquin Local ; <br /> Jdi <br /> e with County Ornance No. 549 and existing Rules and Regulations: <br /> This a r <br /> lication is made in compliant � _,,,• • <br /> PP � <br /> JOB ADDRESS/LOCATI - � - <br /> ------------CENSUS TRACT-------- ---------- --------- <br /> - °---- ---------------- <br /> Phone-- --------k <br /> Owner's Nam :- ._ _, R <br /> - ----- --- �� <br /> -2 City <br /> Address - -----#---- ---- - ! hone <br /> v <br /> .w <br /> - i <br /> _ _ <br /> s <br /> License #����f�--�:--P - <br /> Contractor's Name� ��tcv �. -M-� - ._ _ Y <br /> knstallation,will serve-. F Residence Apartment House.(] Commercial ❑ Trailer Court ❑ , <br /> �... y• Motel ❑ Other--- --------------- <br /> ----------- <br /> = Lot= <br /> :Size_ <br /> �_(G <br /> N�rnber�f...l.iving�r�i#s:_._�.::�--_`_Number of_b -morns--r -. P to <br /> . --wGarba e= rind ----------------------------- <br /> Water ° ------------------ r�a ;b <br /> supply: Pbblic System an_d.nami <br /> Cla Peat Sandy Loam ❑ -Clay Loam ❑ i <br /> Character of soil to a depth of 3 feet: Sand ElSilt <br /> ❑ Y ❑ '.. ❑ , <br /> I , . - Adobe - Fill Material------------If yes,type------------ ----- ------------- j <br /> ';Hardpan [I <br /> (Plot plan, showing size of lot, location of.system in relatio #o.wells, buildings, etc. must be laced on reverse s ) i <br /> NW INSTALLATION: (Noseptic tank or seepage .pit pe�rrr�i �if public-sewer is available within 2d0ee}- <br /> l.S/Si�e.------- --`-`�"-�`•�:- ----------------- } --------------- <br /> �"L'iq d Depth <br />'R PACKAGE TREATMENT [j - SEPTIC TANK [ ] � �. � �:�x� <br /> No Compartments--------- <br /> -=Material. ' <br /> 4 Capacity- ' ='Type r yt a <br />,.. t r.._ <br /> Distance,to nearest:-Welk'- - --------- ---------- Foundation = Prop. Line-_ <br /> - -- - <br /> ®- -- - - Total' Length --_ <br /> l--------------------Length of each line,--- --.--- <br /> LEACHING LINE. �` No. of-Lines-:__- . <br /> I, t } /_-__Type Filter Material <br /> De th Filter Material �l_f- -- --- _ -- -- <br /> D' Box .. ....� .. <br /> l� .Proper TLine i <br /> 1"y <br /> Distance nearest: Weil-��= � --Foundation_- � � No t <br /> REUt Filled Yes � , <br /> S�P�r6E-Pf ' A ` ber <br /> l]epth_� ----:----Diameter_ �/­N <br /> Lumber <br /> t ,....., Si - --------- ----------------------- <br /> -----------Rock S' e±_ <br /> Water Table Depth-.�---- -�----- -------- ----- ,- � �' <br /> F s. oun on - - -- --Pr i ----- - <br /> �. <br /> �� t oP ; ne r ' <br /> Distance to nearest: Well <br /> F dati <br /> Date_.- -`---- <br /> REPAIR/ADDITION (Prev:Sanitation Permit#_._--- ------r_----- c ; <br /> . t I <br /> E --- ----- <br /> 1 - - <br /> Septic Tank'(Specify;Requirements)--------,---:-- -- ----- <br /> ' - _f <br /> .�, �.�� <br /> Disposal Field (Specify Requirem`entsl---- --- - ------ ----. - <br /> j,- c n - <br /> �� <br /> '.. ------- = <br /> r _ <br /> - . . pF -_ _.__________-_ ---------------------------------_ <br /> / _________________ <br /> {Draw existing and required addition on reverse side) <br /> I {{ nd that the work will be done in accordance with San Joaquin! Cou�ty <br /> Hereby certify that:11 have <br /> -prepared This application b <br /> Ordinances; State Laws, and Rules and Regulationsofthe San Jo oa uin Local_Healfh District. Home owner or licensed agents <br /> f - <br /> signature certifies the following: <br /> t i t <br /> "Ilcertify that in the performance of the work for which thus permit is issued, l shall not employ any person in such manner s <br /> # to become subject to.Workman's, Compensatiow. laws..of. California." CLARENCE'S SEPTIC A i SEWER SERVIM i <br /> :Owner .263 So. Oro *.Stocfctdn, Calif. 95205 <br /> Signed-=- c .x= 1 --- <br /> - -- <br /> --- +• � �� � :Title-----'-. --Ph 453-3209----Ci�'n(r ci�c'_s-Lit_-�'r-267 �`�- <br /> I ----------- <br /> 130- — F r^ <br /> (If of er_th Winer} <br /> ,." `FOR-DEPARTMENT'USE ONLY"'" , <br /> - --- ------ ------ -- <br /> 1 <br /> - - -------------------------- = DATE <br /> i <br /> APPLICATION ACCEPTED BY-- = : _ _ TE ---- ----------- <br /> DIVISION OF LAND NUMBER ::.--- -- ---- <br /> -- - ------- -:---------:---- D,4 <br /> t ADDITIONAL COMMENTS-------------------- ---------------- ------------- '------------------------ ----- - - <br /> 1 - ----------------- ----------------- ----------- ------- --- ----------- <br /> ------------ - ------------ ---- ----------------------------------- --- - -=- ---- ------ ----- <br /> ---- <br /> - <br /> ---------------------------------- <br /> ------------ - D ( �,� <br /> _- <br /> _: -- ate -14 <br /> Final Inspection by:_---.---- � --------------- - - - <br /> ' SAN JOAQUIN LOCAL HEALTH DISTRICT F&s 21677 REV. 7/76 3MEH 13 24 <br /> 1 _ <br />