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. FOR OFFICE USE: APPLICATION FOR SANIYATION PERM •7'72--S� i ................ , . ............................... 4 Permit No. ...............• .Y (Complete in Triplicate) r This Parsnit`l:xpires l Year Elam Data Issued . Application is hereby made to the`San Joaquin Local Health District for a permit. to construct and install the work herein t described. This application Is made In compliancewithCounty Ordi ante o. 544 d existing Rules and Regulations: ......i ..r.. . ....... '. CENSUS TRACT .......................... JOB ADDRESS/LOCATION .......... (,.--��"`��- .. .-•` . IOwner's Name .........:. . A-Q..:....... ......:!:.C.. .. J .,. .Phone ...................................... ` Address .................. ........4r2e�-----may........... ... ..............City .. .. ................................. Contractor's Name =License # -,Z .•ZL7"7Phone . ... . Installation will servo: Residence p(Apartment House Q Commercial QTraiter Court Motel Q Other............................................ j ,...... ®. .. f Number of living units:-..-/.... Number of7oo7s .c2......Garbage Grinder Lot Slue I Water Supply, Public System and name ...i ...._......._.....................:....................Prlvab Q Character of soil to a depth of 3 feet: Sand 0 Slit(] Clay Q Peat p Sandy Loam Q day Loam Q Hardpan Q Adobe A� Fill Material............If yes,type ........................... (Plot plan,, showing size of lot, location of system In relation to wells, buildings, etc. must be placed an reverse tlde.} NEW INSTALLATIONe (No septic tank or seepage pit permitted if public sewer.is available within 200 feet,) PACKAGE TREATMENT. I j SEPTIC TANK f 1, ��1$ !-Size.,............................................... Liquid Depth ......................... capacity .................... Type Material...................... No. Compartments ...................... Distance to nearest: Well ...................................Foundation ...................... Prop. Line .....•............ OT LEACHING LINE No'. of Lines ...... ...•......... Length of ach line......&.1. ............ Total Length .4.Q................. 'D�Box . "'. Typo Filter Material ,/ ......Depth Filter Material .� �...-.•..•.••-•• -•-•---••-• k Distance ta" earertt Wb "Foartdation _ .lf .f.. ........ Property Line . ..`..... ... - .. .�.! Number ...... Rock Filled Yea No SEEPAGEIT.. Depth s� ..---•. - Diame � •-•-....�. ! R ' * ""'Wateir Tablb Depth , ................................. ................... . ..Rock Size ..... . ...f............ 0 40 - � A'..Sr4�= Ad..._ ...... Pro Line .. ............. R ►T Distance to nearest: Wells..{� Foundation p- It EPAIR�ADDiTION(Prey. Sanitation Permit qlt- ......---..................- ............... Date ..................................I Sep tia *ank-(Sp�KIfylRequirementsl .... . ..�. .. ............� Disposal Field. (Specify Requirements} ..� - - . . �F. �. • •--.... .. ............................. ................. ......................... ....... ' ............ .r........• .................... .... ........ �(Draw existing and required addition an reiierse side) _.. . I hereby certify that I have prepared thls-.application and that.the work willbedone in accordance with San Joaquin County Ordinance's, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or llcen• sed agents signoture,certifies the following: '1I certify_th"ot in the performance of the work for which this permit is issued, I shall not employ any person In such manner } as to become W t- sub ecto Workman's Compensation laws of California" l P v r ""CLARENCE'S SEPTIC & SEWERWER SERVICE Signed Owns '263 So. Oro Stockton Calif. 952x5" ' - ...:;`_ itle r ►p c#her than owner) FOR DEPAI MENT, USE'ONLY APPLICATION ACCEPTED BY r ~' _. ._ DATE . a 7• - DA V .. .....:..........:.:.. ................. BUILDING PERMIT ISSUED ..�..:.......::. DATE .. ._.._.....,.. _...................... ADDITIONAL COMMENTS - ' .' ...`..:_.. ... .... _._-........ ::... .........:... ....... ............_-__ ..................._.._...............•................. ...I.............................................-....................................I..............__....._................ ... R... ........... Final Inspection b -----------•-•----•........... ....... .. . ...Date �.... .... :.rr?. .:7 . ..... EH 13 2h1-613 Rev. 5mSAN JOAQUIN LOCAL HEALT DISTRICT 8/7h 3H .