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FOR OFFICE USE: FOfZ OFFICE USE: APPLICATION FOR SANITATION PERMIT 77 lfZL ,� Permit No.----------- [Complete in Triplicate) ------------- -------------------- --- - --------------- Date issued.-,'- ----f---- _-------------- 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 a Regulations: r --CENSUS TRACT-- _.----------------------- JOB ADDRESS/LOCATIO " Pne-------------------------------------- -------- Owner's Name-.-...-- 6 cs. -- - Address - - - --- ---City � --- - - - ----.ZiP-- ----- --- --- - Contractor's Name ��-A--- License #c �r `�� pPhone11C'fld�r-(. Installation will serve: Residence` Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other------------------------ --------------------- i [/ -------- Number of living units:---- --------Number of bP��, ooms._ _...__..Garbage Gri d LOt Size__ p T -- r------ ❑ Water Supply: Public System and name.."-....._ __ _. . _ - ------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Fill Material- If yes, type-------------------------------- (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 TANKrr, ' rize-------------------------------- --------------------------Liquid Depth -------------------------- Capacity_----------- Type Material -------------------------No. Compartments----------------------------------� Distance to nearest: Well---------------------=------ ----- ------Foundation--------------------------Prop. Line-------------------------6 1 �Q --------- / No. of Lines_- ....__ -- ------- Length of each --------Total Length --- e�0r LEACHING LINE ,F f D' Box- _--Type Filter Material__---Depth Filter Material----, - ------------------- r ,, DD ---_-Property Line.... ..-- --------- -- Distance to nearest: Well-.�_.Cfi�llP.�.�.Foundation_____ __ _______ ___ p ty �-�-- - ! !! Rock Filled Yes ` No --------- SEEPAGE PIT � Depth.�.�.---Diameter_- _� --._Number_____ _________ ____ _ --------------------------------------- 1-1119 _-.11 , sRock Size--- - - ----------------- Water Table Depth------- - -. - ------------------------------------ is Distance to nearest: Well jfo-_W- --"--- Foundation. 19 ----------- Prop. Line----- REPAIR/ADDITION (Prev. Sanitation Permit#---------------------------------------------------Date-------------------------- --------------------------------------- -- - ---.Date-------------------------- -- ------------------- } Septic Tank (Specify Requirements)-------------------------- Q - -- r Disposal Field (Specify Requirements)_.._--_ f ---------------- --------------------------------- -------------------------------- -- --------------------------------------------------------- ---------------------------------------- --- - ---"---------------------------- (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 licensed 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 SERVI.CR Signed--__--- -------Owner 263 So. Oro � Sto,lcton, Calif. 95245 - - ------------------------------- --- BY -- - ------------------ ---Title------ ----------------P-h-453-3249-- _�ntraftPl__s_Lic_.- `267i7Ti (if other than o er) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- �` ` ------------------- -DATE _X_/.---�'"----- -�- ------- ---------- --- -------- - DIVISION OF LAND NUMBER------ ------------ ------------- -------- ---------DAT .------------ --- --- -------- ------- -- ADDITIONAL COMMENTS-------------------- --------------------- ---------------------------------------------- - --------------------------------------------- � --------- ---le ----------- ----------- --------------------------------------------------------- - --------------------------------------- Date w ----- ---------------- _q__77- Final Inspection by.- - ----------- F&S 21677 REV. 7/76 3M EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT