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FOR OFFICE USE: f FOR OFFICE USE:
<br /> APPLICATION FOR S-AWhATION PERMIT
<br /> IC"plete Vn Triplicate) Permit No---' ----------
<br /> --------------------------------------------------------- y t
<br /> Date Issued__. ` .-72
<br /> --------------------- ----------------------------------- This Permit Expires 1 Year`From Date Issued
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<br /> Application is hereby made to the San Joaquin 6oc.-alleafth District,forT6,peFrla`ittozconstruct and install the work herein described.
<br /> Thtg-appfication-is-made-in-compliance-with-C-ounty-Ordinance-No;54�and-existing-Rtri'e's and'Reg-olations: y
<br /> JOB ADDRESS/LOCATION 7__ „_,-___ � � aZ- � _ -,�/ _CENSUS TRACT -------1-
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<br /> Owner's Name-:--- i n `; i_
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<br /> Address______
<br /> c 4 ' e.. /----- ----- City. / Zip --_---1 - -
<br /> ,s Pho
<br /> Contractor's Nam e_ 1 _: - _ ,, ,�e�_-- ,e CJ )icense #- JC -----Phone__
<br /> InstallationAwifl serve: ResidenceA� artment House * w
<br /> ❑` p ❑ ommercial Trailer Court ❑
<br /> t � Motel C]. . Ot1Z-----
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<br /> Number of living units:___-25r'___Number of edrooms _Gaebagi'GriAer_.-I&.'_-Lot Size------ _..-__-______-_.__
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<br /> W Iter Supply: Public System and name----9-0;)d ------
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<br /> Private)
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<br /> Character of soil to a depth of 3 feet: Sand ❑ 'r!t El Clay ❑ Peat❑ Sangy Loom ❑Clay Lbarn tl
<br /> Hardpan [:] '
<br /> ' Adobe ❑ : kFifl Material_-- -- -__Jf yes, type--'i------------------------
<br /> e.,� 9 � j.,�,.,.a,F ,vim
<br /> [P.lot plan, showing size of lot, location of system in relation to wells, buildings, etc.,Wst b place.d...on.re.verse�sCdI— _.. ..
<br /> '(No 'se ' 'tank°or seepage •pit permitted if public sewer isfava,i_lable,within 200 fe�T;):
<br /> NEW INSTALLATION: a t
<br /> PACKAGE TREATMENT � Siz y/+ �,�
<br /> 1 SEPTIC TANK e-_ �/i (.-- �"- I -_--- ;`--.�-------JL-'iqu id�Depth. '1.r__
<br /> ,1Compartments
<br /> = -----------
<br /> Mat,
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<br /> Capacite __ Material__ o. Compartments_____
<br /> ----
<br /> y" _ Distance;to.nearest;_Well ..------------------------- FoundatEorl- -.
<br /> Pr_pp Lines--_-
<br /> (LEACHING LINE -. No. of Lines. __,-__+�____-____:.i_,._-_- Length f each line., _-�__t Total Length._.___lo
<br /> - --- ---- -
<br /> 'D' Sox /_-:.-Type Filter Material= 4-CA----Depth Filter Material-----/?----
<br /> Distance to nearest: WeILL Foun�rdufion_;� - _____ _ Pro er Line. _
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<br /> SEEPAGE PIT ] Depth—S .....Diamete.r__ ' . ._ _/Number--_ ______ _- Rock Filled Yes No 170
<br /> Water
<br /> DistarieTea-fiool=enearE -�_-- ..,�, Rock Size � -------------------
<br /> J------- -----
<br /> , F 4 }
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<br /> -�---------J-_--_F___.__,Foun-d- at-io -e-_-�__-�.-l--
<br /> --��- _.-----_-_-_-_-_-.-_-.-P--r-o------)L
<br /> ine___
<br /> REPAIR/
<br /> : ___.---- _ _ ate
<br /> liSe tic Tank ISTeclfY e uirements) -
<br /> . - � ---- ---
<br /> Disposbl-Field fSpecify Requirements)4_ :f_$ ___:_
<br /> s —... +r. -------; � s � -------- ------------ ------------ -------- --------------------------- .------ -- �
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<br /> Y ""•may-�it °
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<br /> .`f L t J E , -� ----------------
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<br /> ' (Draw xi,sti�lg ani require addition on reverse side) .
<br /> I hereby,g_eir fi jr bai :have r'ecU-t ih''s applicat n an�fi ah t the work.4ill be done in accordance-with San Joaquin Coun
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<br /> Ordinances, Mate Laws, nd'rRu eScrad RefLulatio�s'of#1ie'�San Joaquin Local Health District. Home owner or licensed agent
<br /> Signe ure certifies th Jfollawing g
<br /> I�certify t�hatpin the'perfoi ante of the-work fo which th s;permit is issued, I shall not employ any person in such manner as
<br /> to become subject td-,Workman's Compensatiop, _laws of� California.
<br /> Signed_ ''' i j GL.ARENCE'S SEPTiC & SEWER SERVIG$ ,
<br /> I_ ,. g __.1" Owner
<br /> - � t - - -.263 5a-Oro 5toc#ctan, Calif. 9520
<br /> By-!. Tit'le------
<br /> 4�1+:X53- E09 Contracirlt'�I i�__ 26711� �!
<br /> (If other thariownea �
<br /> � R.- EPARTMENT'U5E ONLY
<br /> APPLICATION ACCEPTED BY _ - = ---- -------- s---DATE._-------77141517--- -------------
<br /> DIVISION OF LAND NUMBER ------- • 4- - - - `� �` �. ---DATE------------------
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<br /> ADDITIONAL
<br /> ---------------- ;ADDITIONAL COMMENTS---------------------------------;-- :_:. i -r `
<br /> _ •a,
<br /> '`` - =-------------------------------
<br /> ----- > -----
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<br /> -- -. -- --------------- --------- �.-- �-
<br /> -------------------------------------- ---- -"----- - - ----------- ------------------ - ----------------- ---------------------------------
<br /> .� _ ..
<br /> Final Inspection b �.-'- -- _-.-.- _-Date^ -- d _mss -.�7�-- __--
<br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 REV:7/76 3M
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