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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ' =111!P ` Permit No.-7T-_6 [Complete in Triplicate) a--------------------------- ------------------ --- ' ,. -- - � ------ -- This Permit Expires 1 ear 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: AW -� } CENSUS TRACT----- -------=- ----- ----------- Phone -- ------ JOB ADDRESS/LOCAT! N.._--- -- } i -- Phon Owner s Name.... - - -- ---M-. 3 ¢ i Address.------ , Contractor's Name-- --/ -.�,..r, License #+ - - .� Phone " 4 : t ' - - f t Installation will serve: ,,y,Residence Apartment House.E] Commercial 'E Trailer Court.❑,,. . . �F .....t,. ...i Motel'❑ ---------------- ; --- ----------- 1 - # T -Lot '_ y�G._ C_, r Number of living units:____ / _Number'of b rooms J.Other..._*__Garbage Grmcle�r �— ---- ; --- - --- -- - -- Private ❑ Water Supply: Public System and name------ w Character of soil to a depth of 3 feet: ' Sand-D� ilt❑ Clay ❑ df- Pea Y❑ Sandy Loam [2� Clay Loam ❑ ► Hardpan E2 }y Adobe i kFill Material __If qs Ityp t le (Plot plan, showing size of lot, location of system in;relation to wells, buildings, etc.`'mu`sY beiplaced on reverse side.) y n NEW INSTALLATION: {No.sept c-tank sor seepage pit permitted`f publi e e is va aifablewithin 2'OO feef;} P [ ] SEPTIC TANK -Size' ACKAGE TREATMENT x' -- Liquid Depth, - d---d ..r_ Capacity =,Yp?'; . � Material__ � -- t! No. Compartments--- .. r "` r t / _� g _Foundation., /1�K Prop. Line .X Distance to nearest::Well (�_ __ X--- ------- y # LEACHING LINE No. of Lines. ' YPe. . _:_-:;--.Len Length o -each linFilter Material---- e._- .- --_-__-Tata) Length _.._._ �. ----__- - -- -- De th - --- ---- --- - ------ — D' Box- f TFiler-Mc+teiaL . 'Distance to nearest: Well_v'��' ------ umberindation____� .-_--} .---___--.Proper_-ty Line_-._ ----X----- ----i-- c Z _ ] Rock Filled es; No 15 SEEPAGE PIT Depth _Dlamet,601,� F: N tp ❑ B € .. A..�. ] l - Rock Size.---- -- l------- Water �. Table Depth iT-i: = {X .- F � - - Distance to nearest: Well_;°_��--.`-- -------:------Foundation._.�C�--- �__#t_.Prop. Line__'________ _ ..�= -----------:Date------ ------ ----- ] r _ J REPAIR/ADDITION [Prey.:Sanitation Permit# _._..-�- -�_-, .,X� ----- Septic Tank (Specify Requirements) G� �rsC -------------- 40;; f -- ---'� Disposal Field [Specify Requirements)-: 9 = T ' j ---- --------------- --------- ---.---------- ---------------- r; o ----- ----------------- (Draw existing a d required addition on reverse side) i!. i f, I I hereby certify that I have prepared this appliiation�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 that in the performance of the work for which this permit is issued, I shall not emfsloy any Person in such manner as certify p .. to become subject to Workman's Compensation- laws of California." rt i # CLARENCE'S SEPTICA SEWER SERVICH Signed --------- --=- ---- -- -- ner g 263 So. Oro ;;L. Stockton, Calif. 95205 Title---------.-Flt:-4 8s 3209:---�ontraCt '5-tt#2671-711------ (If other than'ownee' l OR ARTME T U E ONLY I APPLICATION ACCEPTED BY _ - ------ ----- - -----DATE.' - ` IVISION OF LAND NUMBER ---------------------------------- DATE---------------------- D -----: r'� ADDITIONAL COMMENTS ¢ �(r_y__.. ------------ AD' i ---4 -------------------------__----i---------- ! ------------------ ----- ------- -`- --- -- --------- - - ------------------------------'------ - --- --- -- ---- - ---- --------------------------------------------------- ---- ---- -- - -- -------------------------------- ' LL Date ------" - ----.- ..� Final-Inspection-by••------ _ ._.-: -- --- -- - ---- EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F85 21677 REV. 7/76 3M