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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - -7 "----------- -------- -------- -- - - (Complete in Triplicate) Permit No.:7. _.-.-B..._._ ------------------------------------------------------ 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: i t ti JOB ADDRESS/LOCATI N...... ._C_(-------- -------- -- -f'tJ: _ ...........__,-__--:---CENSUS TRACT.--------- Owner's Name. -� -C--------- - ' `--et'c'...`-----------------=----- ' --- ---- Phone -------------------I--------- ---- Address...-------FF - - ------------------ ---- ------ City - --- ---- ---- --Zip---- - -- Name t-e ""� �__.�__..__-._ •--•_��-- _/"�*�''°License. �.��-7 ( -._Phone_ --__- -- „ - _ _ ,. --- 17 Installation will serve: Residence" Apartment/House ❑ Commercial ❑ €Trailer Court ❑ a . Motel ❑ Othre'r. Y - -------- Number of living units:_ ---__Number,�of bedrooms.. __Garbage Grinder_ of Size_--' ize "��''.� "a- - Water Supply: Public System and'narr5e___ _._I�W'F __ _ _____________________�._. _ _ '- Private'��'° Character of soil to a depth of 3 feet: Sand [] Silt❑ Clay ❑ . Peat ❑ Sandy Loam E] Clay Loam E-1_ Hardpan Q : �Adobeg s Fill Material-------- If yes, type---=---------------------------- ' ' k (Plot plan, showing size of lot, location of system in relation to wells, buildi-ngs,'etc.'must be.placed on reverse side.) } NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) r V —PACKAGE-TREAT _ -=� -1-- ;=_ _—Liquid-Depth.---�--- W 4 Capacity Type Mcit ial No-C-ompartments. - --------------------- -- Distance to -Distance.to nearest; WeIL:__A` ,__ ;_� .-Foundation. / ......Prop. Line f-_-. LEACHING LINE No. of Lines_.. :__Length of each line---- - __________Total Length.-_.._ ______ r 1 � i } 'D' Box.-,./--"-..Type Filter Material: -_-.Depth Filter Material_.- --- ---__.---- -___.. f r= �. :. . i DC7,- A-I . i Distanc6to ne�est: Well .� __ Foundation_ C _ _ Property Line---- ----------- SEEPAGE PIT Depth. _'-__Diameter.__ ___.-___Number___:____-*�---------------*_ Rock Filled Yes, ° No [7 �. Water Table De th-- :< - --------------------------------- Rock Size--- � / ' 4 ---- 4t Foundation------L: ..- k .Prop. Line D_,ist5nce.to nearest;Well_.°. : REPAIR/ADDITION"(Prev. Sanitation Permit -_ -_- t f r Date------------- 8 �- } 5eptic Tank(Specify"Regbirements)__-..__ __._ -- _ ----_ --------=--- -----_ - -- s .�� .. > --- �.x..-- --�.__. -- --------------------------------------------'"�.� � � � � � Disposal Field{Specify Requiremer''fis) --- _ ------------- _ = - - -- ------------------- ---------- { (Draw existing and required addition on re erse side) j jv`q 111 hereby certify that I have prepared .this application nd athat the work will be dceoneAn accordanwith Sal Joaquin County Ordinances, State Laws, and Rules-a_nd-Reg ulations of, tilde Son,4oaquin Local,Hea h'District. Home owner or licensed, agents signature certifies the following: # E IN, :.� i'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." Signed-:-_-- _ ----- Owner C &oSEV1ER SERVICE CLARENCE'S� SEPTI E ----- ---------- -- -- ------- ---- --- ;" 263 So. Oro - Stock n,'Cairf. 95205 IBy - - . `-- - - =-------- Title---------Ph:-45 - -- # 3-32{i8 Ca is s L F (If other tli ;owner) a FOR DEPART ENT US NLY APPLICATION ACCEPTED BY . - rz - DATE.------ -- ` ----- DIVISION OF LAND NUMBER ----------------------- --------- -------------------.DATE ------------ ------------ ---- -------a---` - - --------------- -------------------- DDITIONALCOMMENTS---------------------------------------------------------------------- --------------------------------------------------------------------- ------- ---- ------ - ----------'-----------=------------------------------------------=------------------------------------------ -- ----- ---------------------=---------------=--- -=----- 1 _--- _ __ �--- � -------------------------------- EH - Final Inspection by. ��-------- - - --- -------- ------- -==--------------------------- -- ------ - - ---Date- ---------�- --- - -- - - cN 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 REV. 7176 3M