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FOR OFFICE USES ICATiON FOR SANITATION PER _ (Complete In Triplicate} Permit Na22:� . This Permit Expires I Year From Date issued Date issued�..`S 7 7. t 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 ma/de In compliance with County Ordinance No. 549 andexistingRules and Regulationst � JOB ADDRESSAOCATION .... .1• ...... ./.l• ��1.t�.t�I �, ../l• ENSUS TRACT .......................... Owner's Name ..... .�....A...!........ Phone .................................... Address ... ......�.1� i� ,/ �i�r'._..City _. Contractor's Name .-: ,,1� ..5 ..- ..� .., l,iicen:e p `/�I..:ft a I Installation will serves Residence Wpartment HouseQ Commercial❑Traller Court ❑ Motel❑Other Number of living units:...` Number of ms .. Garbage Grl der Lot Size ..... ... Water Supply, Public System and name ...... ... .. .........................:....:..�.�..Prl -- -ate Character of soil to a depth of 3 feet: Sand D Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam❑ Hardpan' Adobe❑ Fill Materlol ............If yes,type............... ............ (Plot plan, showing size of lot, location of system In relation to wells, buildings, ate. must be placed an reverse side.) NEW INSTALLATION: (No septic tank or seepage pit,perm ed �f public sewer is available within 200 feet,) .moi/ h PACKAGE TREATMENT ( ] SEPTIC TANK j /�� ze................................................ Liquid Depth .:........................... Capacity .................... Type .................... Material...................... No. Compartments ..................... S Distance to nearest, Well ...... ..Foundation .. Prop.-Line � p ..................... LEACHING LINE No. of Lines ......./............ Length ........... Total LengthV. (V..............Q 6 i 'D' Box .:z`3 Type Filter Material l.f'S�!1:....Depth Filter Material ./..,� ............ .•�••.-••••- r > Distance to neargsts Well-4--a.•......�. Foundation ./V............... Property Line ... . ........ SEEPAGE PIT Depth <N7' ~....... Diameter -;Z-3....... Number ......./................. Rock Filled Yes J2r No C]O i Water Table Depth ....._..��--.��..............................Rock Size ... . ............:.:......... Distance to nearest: Wel( /CI P.�........................Foundation •- lQ•••••.•••. Prop. Line .................. REPAiR/ADDITION(Prev. Sanitation Permit .7$ .�1 `f j-• ��' 71_: Date .........•..:............ Septic Tank (Specify Requirements) ..............7•. ~$3. .... _..._............ ....� ..... ... Disposal Field (Specify Requirements) . . �` G? ••�� .... `` "-•-... ... d ........................................••--•-...................t .. . ... . .................__......... .........................................-•----...................------•............._......I....----•----._.-•--- ..........._................ (Draw existing and required addition on'reverse side) I hereby certify that i have prepared this application and that the work will be done In accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District.Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit Is Issued, I shall not employ any person In such manner as to become subject to Workman's Compensation laws of California.". CLARENCE'S SEPTIC & SEWER SERVICE Signed •- .......... Owner 263 So. Oro u Stockton, Calif. 95205 ........._. Ph-463.3209 Contractor's Lic,.#26717-2 Title .......:......... (If other than own F R Dr USE O LY APPLICATION ACCEPTED 8 . ... x.... DATE .... -` `.. . ............. BUILDING PERMIT ISSUED .....................:.............. . . ........................DATE ......................................... .. ADDITIONALCOMMENTS ......................... .. ........................................----..... .......................... :........ ................ ........•--......................---...........---:................................. ................................................................... .................................................... ............................. ......�.... ..................... .....................................P..... ... .... .............................. .................... .�/.l.� Final Inspection by: ..................... �! � .....Date .. ......v. .../. ........... ........... lE 13 24 1-611 Rev. 5M SA JOAQUIN LOCAL HEALTH DISTRICT 8/7L 3M