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FOR OFFICE USE: FOR OFFICE USE: APPLICATION -------------------------------- ------- --------------- (Complete SANITATION N Triplicate).-PER'MIT:�1.�. Permit No.... -�'- � Date Issued--- 7--/� -7 a --------------------------------------------------------- This Perrn'irExpires :Ye-ar From Date Issued. Application'is h_e�eby made to tthe San Joaquin Loca! Health District fora permit to construct and install the work herein describ d. t This application is made in compliance with County Ordinpipce No. 549 and existing Rules and Regulations: JOB ADDRESS/LOC XON....._ ..�.�.� � ----. �.. --- ------- CENSUS TRACT-------------------------- I ir Owner`s Name �`c -----=-------' - Phone. Address ?� ��:----- = �Y [d :.....-_CitYj Zip F - . Contractor's Name, ,i�.,� ...�� __ ...,d, 44A License #-,-2- Installation will serve: Residence' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other-------.-:------------------- ---------------- Number - ------Number of.living units: -_ ------NOmber of b rooms...' Garbage Grinder-(5;''•: Lot.Size... .0--- - �_j-_ Water Supply: Public System and name.._..__ _:_•_..,_44.. _.. =- =-------- -------------------------- - :_�_Psdvate Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat ❑ Sandy Loam .Clay Loam ❑ _ Y �_. _-� Hardpan❑ ' Adobe.❑ Fill Material elf yes, type._'- .. ............ \ (Plot pl6n, showing size%#�lot, location of system in relation to wells, buildings,etc.must be placed-on reverse side.) p NEW INSTALLATION: `(No,septic tank or'seepage 'p-it permitted if public-sfer is available within 200 feet) ' T Y-1 �..r. 1 PACKAGE TREATMENT [ ] `. SEPTIC 4TAN'KSize--�-- - ---- ��-----------------------Liquid Depth..___�------------..... \ L �/ G41T e. Material_,_ � . ..�- ,...-►-- • Gapacit YP --� �------ ------ - -No. Compartments_---�__�_�`__- ---------------- --- 177 t f stance to nearest: Well....�a1.. ---=- ------------- Foundation. �P�. -._...____ --Pro Line --- --------------- DiG iP t '3 LEACHING LINE o. of Lines; ----............._.Length of each line .- t ,,__.'.,-. ,:.....Total.-Length.:. _ _ . �r D' Box-.f . --Type Filter Material: s _ p terial /9---------------------------- --------------------Depth Filter 1V`la :-- -- - -- -- alio � 1 p ty i Distancato nearest: Wel!_: __..-.-.....Foundati�._-Y -------- '....Pro er Rock Filled Yes--" � No • SEEPAGE PIT I Depth,2.�_s____Diameter- a .. ...........Number._- ____ Water Tdble'Zepth_ Rock 'Size--- tom-- .--------------------=---"--------- £ , I } �istance to nearest: Well.: .-------------- ------Foundation./ -f Prop, Line------r-- REPAIR/ADDITION.[Rrett.�S-drPitation Permit#_ - ------------- .--Date,------------------ SepticTank (Specif Requirements)------------------- -=------------------------- ------------------:------- ----------------------------------------------------------- --- -- 1151 - Disposal Field (Specify RAuirements):--.---- ----- - -------- -------- ------------ --------------- --------------------- ----------------•------------------------------ --------- ----- I -------- ------------- ---------- t --------------------------------=------ --------- (Draw existing-and required laddition.on reverse side) hereby certify thatll have prepared this appliiatiion and that the work will be done in accordance with San Joaquin County Ordinances,- State_ Cows, and Rules and Regular ons sof the San Jodquin Local Health District. Home owner or licensed agents , . t signature certifies the following: ' 1 t i t "I certify that in the p'�or"M"ance-of thT he work for which this permit is issued, l shall not employ any person in such mariner.t as Signed_ W s.of California." WRENCE'S SEPTEC &' SEWER SERVICE -- - --'�Y_.--.--<w- FOR'DEPARTMENT - iOvvnsr Zfi i S4. Oro x Stockton,.Calif. 95205 tobecome subject..to- Work Vis, .Com •ensatiw law tt 1 . ....- # }��. `--- �2--� I.]---nLiUI S-- -. 2�71.sl� "•• �. _; = Title By- - _ E i {if otlie�than orT- ' USE ONLY r APPLICATION ACCEPTED . - : --------------'-----------------------------------------= DATE.'- --------------� DIVISION OF LAND NMBER------- - ------------------- ----:-.-- ----r----------'----------- DATE- t--- ADDITi6NAL COMMENTS------------- ----------- -------- -'------ ------------------------------"---- -- ------------------------- -- - --- -'-------- ------------------ = -------------------------- - - ------- -------------------------------------------------- ---- - -- y� --------- ---------- - - --- -- - - --- ---------------------------------------- ------------ , ,..,.. ,,.. .__ . . J _ €t� t `�'----- ------------------------' � aef-------- ------------------------------------ 4 *71 Final-nspection--bY: EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 REV. 7/76 3M