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FOR OFFICE USE: FOR OFFICE USr:"' 6 APPLICATION FOR SANITATION PERMIT �j ' --------- --------------- ¢ Permit No.// �(- (Complete in Triplicate) ---- - --- G-3--- Date issued__________________. ` _--__-----------------------------_- ----- This Permit Expires 1 Year From Date Issued i 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: r� cam- --CENSUS TRACT-------------------------------- t JOB ADDRESS/LOCATION Za l .?- - - - _ / Owner's Name. _ - �- ---------------------------------------------., -- --- Phone - Address-----------/0-:7--s—S-76------ ..�------ /`� City - Zip g Coi�tractar`s Namerl f.ei�4 - k�=-t`icens`e # -/-1 P}ione- - --- ------- ------ " Installation will serve: Residence ;' Apartment House.❑ Commercial ❑ Trailer Court ❑ r ,. Motel ❑ Other----------------------------------------------- ' Number of living units:___--./ .----_Number of ed rooms - -__.Garbage Grindar__ "-Lot Size----- fr_ -_ _ -_ ------_.._._____ __-_-. 7 i i Water Supply: Public System and name-.___ - - ____________________________Private Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam N5," Clay Loam ❑ f Hardpan ❑ Adobe ❑' Fill Material------------If yes, type------------------------_--.--- r I {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,) O PACKAGE TREATMENT [ ] SEPTIC TANK Size.: o*_!�- .__�• _�± ----------------- ----Liquid Depth._sa�---_________._4___ Capacit,44104'*rType- ._-- ate�rial--. a -.-- _No. Compartments-..___ ____________________ � Distance to nearest: Well.---/�------------------------ Foundation__ w_r----------Prop. Line.. LEACHING LINE [� No. of Lines!,-A------=-------------Length of eac line----r�-r.------- .Total Length -_- �f .--f_____------- ef ► D' Bo --_Type Filter Material- _- ---Depth Filter Material_--1 ______--------------------------------- x-10 / y to nearest: Well---` /-.---____Foundation--._--lCl..-�- Property Line----- ' ----------------- Distances '____ SEEPAGE PIT Depth._Diameter._-_ __:__--Number--..__ ---------------------- Rock Filled Yes,[ No Water Table Depth - --c,_ 1------------------------ ------ --------Rock Size--- 1-Z-- --�---------------------------- Distance to nearest: Well-___��_--�-------------------Foundation----��___`�___:--_.Prop. Line_.-s4 .__-� REPAIR/ADDITION (Prev. Sanitation Permit#---- --------------------------L------ ----------- Septic Tank (Specify Requirements)------------:----- --------------------------- ---------:--------------------------- ---------Q;.---------------------- ---------- Disposal Field (Specify Requirements)----------- =------- = - �` --- A- --------------- ---- --I -------- ---;----- F. e+ -----`--------------- --------------------------------i----- --- --------- — — ` 4 (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 Heal t1ZADistrict Home pwner or licensed agents signature certifies the following: [ j "I certify that in the performance hof the work for which this permit is issued, I shall not emp�ay any persoh in such manner as to become subject to Workman's `Compensation laws of California.'.';-..? j � i� - LARENCE'S SEPTIC & SEWER SERVICE s a - : - - - ----- -u---E--- . o�LdE Signed--- - ------ Owner Ph26436S3o-.vZO4ro9 e'#I er'sCta]ICii.. 9652T02_75 -- ------ -.BY (If other than own F a OR. ,EPARTMEN�WSE ONLY APPLICATION ACCEPTED BY.------ -- ''" ; �--- - `r.-- ---- ! -------- ----- DATE ".. DIVISION OF LAND NUMBER ---------------------------------- ------ -- - i - ' ., ADDITIONAL COMMENTS-- LL �5 }` -------------------- -------------s "`" _ ;9 : ,� :. --------------- -------------------------------------------------- ----------------=-------------------------- -' -------------------------------------- ------- .--- - - -------------- --------- -- -------------------------------------- - - Final.Inspection-b CJl - Date.-- r't.,= EH 13 24 SAN JOAQUIN'LOCAL H�AE'T.H=biSTRICT Fps 2`6'7 REV. 7/76 3M