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r FOR OFFICE USE: FOR oFriCE u5t: i APPLICATION FOR SANITATION PERMIT C '" 1 --------- -------------------- ----- ----- Permit Na l._ r (Complete in Triplicate) ... ..---------- _ ..:.......... ---------- -------------- S �. ._ ._ .. .---- : _._. Date lssued .........:.................................:...---_..... 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: ( JOB ADDRESS/LOCATI ... �.''�. �•-..L ..... ----- --- .............. -•--- CENSUS TRACT.. --..... Owner's Name._.:.. � .....Phone--- ------------ --- -- ...._. Address...... tr .....--- C.3C / '.... "':.: City_ .� - Zip C? � 0'' - _. /� Contre�ctor's Name. -d _ License #.> - / Phone__ (�--S-----Z -�-. f Installation will serve: Residence ApartmentHouse ❑ s:Commercial ❑ ` .Trailer Court ❑ Motel ❑ Other - = -------------- ------- Number of living units:--..�---__--.Number of bedrooms.._ . .Garbage Gtirider.° _.Lat Size_.+............. ....___.._.....-_..._......_... ._. Water Supply: Public System and name.--..T ..: .....i'r�!�._ !` Private 2r �. Character of soil to a depth of 3 feet: Sand y -.Silt 0 Cla . ❑ o'Peat ❑ Sandy Loam 0 Clay Loam ❑ Hardpan ❑ Adobe F111,Mater al's ... ... If yes, type.......... r........: ..... . i 7 (Plot plan, showing size of lot, locatio of system',,in�relati n to wells, buildings, etc. must be'placed_on reverse side.) x �" ...:a pi . � � .� 200 feet,) 6 NEW INSTALLATION: (No septic tank or seepage pit permitted�if public sewer 1s available within PACKAGETREATMENTY[ J 'SE� �° C�Q4�Type. Size ter ._ ..xll . _No. Com griquid Depth---- --------------------- -,y_� .> . Ca Tacit. � � � p invents-----� ...... ............• rlD'stance to nearest: Well-- ._ .-Foundation---1Q ...-.Prop. Line. .: JQ..... . .---... �. LEACHING LINE Na. of Lines.... --�..__._.-......Length of each line.- �,�' Tota! Length ..�r.�f ':-�'-.- :'D' Box ...Type Filter Material---- C/�_..De Depth Filter,Material. ._ P Distance to nearest: Foundation__..- -. ------- Property Line..... . - SEEPAGE PIT Depth ,...-...Diameter-.17--t-�_.Number.-_- ___________ _______ Rack Filled Yes " Na 3 Water Table Depth.-----• Rack 5ize......." -? - r .. '------------- - q� ------.....Foundation...--- 0 ......L.Prop. Line.-�0------ Distance to nearest: Well.__�O'Q...:............. i i REPAIR/ADDITION (Prev. Sanitation Permit#---------------------- ....... ..__..__...�Date----.--.:-----..-----...---------- -..._) Septic Tank (Specify Requirements).... . .----........ ............ Disposal Field (Specify Requirementsl....... .......------. .........-------------------- -- ..._..--------- ------------------ --------•-•---- i ---------------------------------------------------------- ----------------------------------------------------------- (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." CLAREPgCE'S SEPTIC & SEVdER SERVICE Signed.--... -----.Owner 26 So. Oro * Stockton, Calif. 95205 Pt.a63-3209 C�rir =er's Ljc.-.-267177 SY Title.--- -_------------ -- r � . ----------- i (!f other an owner) i F R EP TMENi E ONLY APPLICATION ACCEPTED BY------- ,pp . ".^ ------ ---------------------------DATE DIVISION OF LAND NUMBER......-r..- ....... Fl� ----.._.DATE---- --------------- ------ ....... ... ADDITIONAL COMMENTS._._ ' _ ..c4.\.<.........S�`'� --------------------------------------------- -- ------ -------------------- --------- ------ -------------------- --ti---- ......--- --------- ------•--• •--------------- --.........- _ w _. ...:: _ D t _ --------- �.y.�.. J — . _ __ �.T._ _ Final inspection by........... •---------- -----------` .... F&S 21677 REV. 7/76 3M EH 13.24_.„ T _��.._ _ _.� .� :,-SAN_JOAQU.IN.LOCAL-HEALTH-D.ISTRICTM