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FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT 'f11 <br /> --------------- - --------------------------- (Complete in Triplicate) Permit No.- -.{- <br /> ------------ --------------- ---------------- ----------- `�'"'""""". Date Issued-,),—* <br /> ------------- -------------- --- <br /> This Permit Expires 1 Year From Date Issued <br /> F Application is hereby made to the San,Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliar'ice with County Ordinance No. 549 and existing Rules and Regulations:_ T <br /> r ' <br /> JOB ADDRESS/LOCATION. ---- P /� r--- �-.CENSUS TRACT------.------ ----------------- <br /> ----- ---- - <br /> r .r. f <br /> Phone <br /> Oner's Name s .� <br /> Address .: ----City- <br /> ------- <br /> License - <br /> contractor's Name J: ; r � ,f i <br /> Installation will serve: Residerice' 6Apartmen"t House ❑ Commercial ❑ Trailer Court [1 d� <br /> Motel OtherG = ` r' ...,�� F I <br /> ❑ arba 5 <br /> Number otliv.ing units:_.;--. -----Number o Wro& s,- j ge Grinder�'Cotjize--_-_= I�_C�" ��� ---------------- <br /> j I I j Pr.ivatA <br /> I <br /> Water Supply: Public System and name--- -�:,_ .--.}6 -- S __----- ------ ------ ! r } �` <br /> d ] i ! � <br /> Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat[_1 Sandy Loam E! Clay Loam El , f <br /> - "Hardpan D Adobeo�< FiLl-Material-------------If Yes, type------ -------------------�ti <br /> ! S. ! t V 1 <br /> (Plot plan,:sh�ow,�rg side of loty locat;on of system din relation to wells, builcings, etc, mush be placed on reW+arseside.] # L� <br /> y `septic tank or ee.page pit permitted if pubic-sewer is available within 200-feet,) <br /> NEW- INSTALLATION: (Nom i <br /> E REATM-ENT---- l"� 'SE'PTfCTANK' -f �a�'/ --- Liquid D pth =-- ` <br /> atel iaL_ ?jrNo. Compartments .___-- -----• ------ <br /> PACKAGE <br /> i \ ` Capacity -ld�'- 7f� Ye t C r / <br /> Distance-to nearestWell .__.__ _r______-"--___.---.-"_Foundation.- - Prop. Line------ Y__"--._- Q <br /> LEACHING LINA [,}�l>la. of Lines -_`..`'- ---Len[th of.each line ::' -Tsotal Length. i <br /> l <br /> 4 t . <br /> T <br /> D'.Box°- ------_ -TYpe F.1�lter Materials----- ------------Depth Filter Matenah_ ----------------------------------- -----i------- ------- <br /> { _... v ,.. � .. i <br /> Distance to nearest: WeI <br /> �• ��.�.. ''� '' t - l---- -------Foundation- � <br /> �tf <br /> --- <br /> --------- --- <br /> _ Rock Filled Yes NaL <br /> SEEPAGE ------ -- e------ Number ------------- --------------- - <br /> rS`� ---------- --------- -------------------------- <br /> le- � Water Table Depth_-.- ------- - ---- Rock Size <br /> • <br /> Distance to nearest: Well- __ ------------------------- Foundation------------_--------- <br /> .Prop. Line-.-___"- -._ ' <br /> i + <br /> REPAIR/ADDITION (Prev. Sanitation Permi -D to---- ---- <br /> Deptic Tank a! Field(Specify Requirements)--:---- - -------- - -------- <br /> - -. <br /> IV. <br /> (Specify Requirements)--.- - i <br /> r <br /> i .�- <br /> -- _ , <br /> ------------ ------------------- --- - <br /> 4 i i <br /> --------------------- - a -----(Draw existing --- <br /> and required addition on reverse side) <br /> I hereby certify that 1 have prepared this application and !that the work will be done in accordance with San Joaquin Coun 1 <br /> Ordinances, State Laws, and Rules and Regulations of-; the San Joaquin Local'Heiii hDistrict Home owner or licensed.agenti <br /> signature certifies the following: <br /> "I certify that in 'the perfoirn nce of fwt,work for which this permit is issued, I shall not employ any person in such manner as <br /> to become-subject to Workman's .Compensation laws of California." <br /> ti <br /> I CLARENCE'S SEPTIC & SEWER .SERVICE <br /> Signed _ Owner <br /> 52O <br /> - 263 So. Oro Stockton, Calif. '9 <br /> ---------- r Title--------Fh <br /> B �� ----- ------ -- -- - .. .453=3?fl9 ---CQntraetvr`stic:���fi7i-j�--- <br /> Y , <br /> (If other than owner) ` <br /> i, OR' EPARTM N US ONLY <br /> APP�LICATION ACCEPTED BY---------- - -- ---------- --- ------ <br /> ------------ <br /> --------- -----------------DATE ---------- - ' ------- - <br /> DIVISION OF LAND NUMBER. = f ` --- . DATI=. <br /> ADDITIONAL COMMENTS--------------JI------��L �����----�� = <br /> 3 <br /> --Ot -� <br /> ---------------------- <br /> - ---- ------------- --_-- � <br /> �....�... _.- ._ . --- <br /> ----- -- - ----- Y = =;�; � - 3A <br /> - ------ ---- <br /> - - <br /> -- ---- -- to - <br /> Final Inspection by;------------------- <br /> - - ----- ---- ------`--- clan � a <br /> �. �.. <br /> r„ - — ---- F85 REV. /7b M� <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT <br />