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FOR OFFICE USE: FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT ------------------------------------------------------ i\ :"r-i-2 f- (Complete in Triplicate) Permit No..._.____._.__._.___ Date Issued---- --------- -------- ___------------------ ----------------------------------- This Permit Expires 1 Year From Date Issued 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 made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIO �, - - _ __-- --_-I.:_ .--. _ 'CENSUS TRACT Owner's Name. ' Phone. -- - --------------------- ------ -- Address ��.< Z.. �(� ��i/ fi City_ . ZAP Contractor's Name_f ._.___. License #.+a` _ '_ r°Z ---Phone-.Iz/. X !�-4'?.� Installation will serve: Residence Apartment House.❑ Commercial F-1N Trailer Court E]Motel ❑ _ `Othier_ Number of living units:-----/-----Number of b rooms-_.7.--Garbage Gri.n._d_e._r._--.. _ ._-.__.Lot Size---- -----��.ls--f. 31- .- -------_- GJ - -----+4-------------- ----------------------------Water SuPPIY Public System and name--- � � Private ❑ Character of soil to a depth of 3 feet: Sand Silt El :Cloy F] Peat❑ Sandy Loam E] Clay Loam ❑ "' Hardpan E] Adobe Fill Material---_._.__ If yes, type----------*___,-__._________ _ y (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,] L PACKAGE TREATMENT [ ] SEPTIC TANK I Size_ __*_,'/_C__------------------Liquid Depth.--.-%S---- ------ Capacit/&6V_6 ,Type_ �,_Waterial_ .1- -- - No:-Compartments4_--�r- -_______________ Distance to nearest: Well.. S,, �, _Foundation_-__ {.�'" e�1 -._� �� - Prop. Line-----6-------------- •-§� LEACHING LINE >FLAK No. of Lines_.___-----------------Length e _ _ r--_ - 'D' Box.._f_ :Type Filter Material_. Depth Filter Material_,___ ________ -_____________________.__ Distance to nearest: Well... __�Foundatiori..��.�__.�__V,_3---Property Line_---- __Ire I � SEEPAGE PIT [ Depth . ,Diameter_ .----Number______ Rock Filled YesX NOL] 44.3 ;�- - r Water Table,,Depth______-9 ____,--------------------------F__-��'____-Rock Size f__ Distance to nearest: Well ___ ----------1_.Foundation---r0----r-------- Prop. Line_____ ________�__ REPAIR/ADDITION [Prev. Sanitation Permit#----------------t_____-----------.-_-----_' -- _.Date----------------------------------------------1 SepticTank [Specify Requirements)----------------- ------- -- ------------------------•-------------------------------------------------------- ---------------------------- Disposal Field (Specify Requirements)-------_--------------- _____[_ __ ---- _ --------------------------------------------------------------- ----------------------------- --------------------- -------------- -------------------------------------------------------- �' { -------------- --- .� t(Draw existing and required addition on reverse side) I hereby certify that I have prepared thin 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 licensed agAts signature certifies the following: { "I certify that in the performance of theworkfor which this permit is issued, I shall not employ any person in such iiianner'las to` become let Workman's Compe atioa la sof California." CLARENCE'S SEPTIC & SEWER SERVICE Signed_____ _______ ___ G =-t<i-C, _ ----------___.__Ow 263 So. Oro o Stockton, Calif. 95205 By----------------- ---- -- .. Fh.463-3209 Contractor's _#26717 _ =e ------- Title----- -- -- -- -------------------------------- w - ------------- ------- (If other than owner) / FOR.D9.PART,MENT-JUSE O 4 APPLICATION ACCEPTED BY---------------- ---------------' DATE----- - - I. -- - -2 ---------- ---- -- - DIVISION OF LAND NUMBER---------------------_. _ -----------DATE------------------ ------- ADDITIONAL COMMENTS - _ ----------------------- --------------------------- ---- ----- ----- --- ,�s off- - z�----- 33------I's_77----------------------------------------------------- -----=----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------- --- ----- ------ ------ -- ------------------ - - - - ---- ----- - --- ------------------ ---------------------------------------- --- -- - Final Inspection by:------------ _- ------ -_ .: ----------------------Date------- �� ------- -- EH 13 24 SAN JOAQUIN LOCAL HEALTH MSRICT F8s 21677 REV. 7170'