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-.FOR OFFICE USE: FOR OFFICE USE: ` APPLICATION FOR SANITATION PERMIT w.s - _ -- - - - -- (Complete in„Triplicate) - Permit. ---------------- - -------- - - ----------------- �- _ - - Date Issued_I__�_-'2� 7� ---•----------------- --- ---- ---------------------- -- 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 Re ul do : JOB ADDRESS/LOGAT N.__ _l L- -�-___d` '�_ . ��-�we- ._. A __,.ewe ------ Owner's Name. -- ---- - -- ------------------------ ---�----, .-- -------- --Phone Address-------- ►+- --= - " --- - s _ 'rty` - -- dip------ -------- Contractor's'Name _ f 1; � --- ---------A44cense # [-r.� --Phonelo �..Z�� a Installation will will serve: ' f Residence Apartment House E] Co mercial ❑ Trailer C-errx�f- f .� �+ .. .�..� Motel ❑ Other-,', 100 �Q-[tc•• ?�__ ' Number of living units:----- ------Number of,be rooms--- _Garbage Grinder_._'&-.Lot Size.__. - " Water Supply: Public System and ------ ----- -----------name---_ _- -- - � - ---------- _ - ----------------Privat e A' ; Character of soil to a depth of 3 feet: San '❑ Silt E] Clay E] Peat❑ Sandy Loam' Clay Loam Hardpan [:]-'- Adobe E] Fill Material__ --------If yes, type___________________ - ❑ r (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,) PACKAGE TREATMENT '[ ] - SEPTIC TAi�IfC-- ,�- M � " P-- ---�--1----------------------7-Liquid Depth.---------TYPe terial-. No. Zompartments -' Distance-to.nearest:,Well.-_V� ------------ ----------Foundation--_- —q -_e--------_Prop. Line__ LEACHING LINE ><jNo. of Lines----_--- --------------_Len th o (� - g f each line ----Total Length ---- r2---&--------------------- D' Boz_°_ __ __Type Filter Material__ -.Depth Filter Material-.--G/ { Distance.to'hearest_WeIL4_� ..___ _____-Foundation____._) ___ ---_;_Property Line.%.�___ ----- SEEPAGE PIT X De th_ '"'! —`T'�3 r - '�.. _ Rock Filled Yes � No ❑ �' p -- -Diameters------- '.Number-------•�------------------ �*,.. # Water Table Depth. fes' Rock Size- " Distance to nearest: Well--- __________________Foundation--"" Prop. Line___� --- -------- - REPAIR/ADDITION (Prev. Sahitatioin Permit,# -- -------------- _. .--.- --------- - Date----____________________-_._____------------- ) -- - Septic Tank (Specify Requirements)----- - - - -- ------ (;ee - --------- --- ---- -------- Disposal Field (Specify Requirem nts)- --- -------- -- /t ---------------------- - ----------- ----------- -------------------------- ---------- --------------------------------------------- --- ----------------------------------- -- (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,anJ'Rules and Regulations of the Scm,Joaquin Local Health District, Home owner or licensed agents signature certifies the following: "I certify that in the perforniance'of-th-6—,W rk 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 sEP-i#C & SEbVER SERVICE s Signed ? Owner 263 So Oro Stockton, Ca!jf. 95205 BY - --- , Title Ph_ 4063,3209_ _ Cc�lra�t9rs_Lic_ 2&7JZ (If other the wrie)r)" FOR DEPART T ISE N LY 4 APPLICATION ACCEPTED BY--------------- -- ------------- -------- --------- -------- ---------- --- =--- - ----------DATE------5��3_l1? - ---------------- DIVISION OF LAND NUMBER.--------------- ----- ------ -- --------------------DATE---- ------- --------------------------------------- ----=---------------------------- ADDITIONAL COMMENTS----------- -- --- -------------------- -` - --------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------- ------------- Fin>4-Inspection•by:.— _ .� - .-... -- -- Date EH 13 24 �� _ _ SAN.�JOAQUIN LOCA HEALTH DISTRICT y . F&5 21677 REV. 7/76 3M