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APPLICATION FOR SANITATION PERMIT t <br /> �/. . ...T.............,l� �.......... (Complete In Triptkah) Permit No. .77..'.�. 'Z. <br /> F '.... Thli Peri tlt Expire:1'Yoar From Date Issued Date Issued 6: ..? . <br /> i i <br /> Application is hereby evade to the San Jopquin Local Health District for a permit to constoVd and install the vfbrk herein <br /> described. This application is made In compliance <br /> with County Ordinance No. 544 and existing Rules and RegItat#ons: <br /> SOB ADDRESS/LOCAYO !4 4.. :...(, /.� ¢ ..., ... .....CENSUS TRACT' .............` ............. <br /> Owner's Name ...... <br /> s . . .. Z��,44 : Phone ..............................Address ` C.r......... <br /> e.�• :..-•••...'CIty ..:.---... .............. <br /> Contractor's Name .. €xr.Lir:ense # Phone <br /> Installation will server ResldencefirApartment House❑ Commercial❑Trailer Court ❑ <br /> Motel❑Other........I.................................... <br /> Number of living units,.../... Number ofi ....Garbage der .' .4 lot Size ..6.0...,er.. .g......, <br /> Water Supply, Public System and name ..'b� ...- -- �et1 ......._................................... •. ...Private ❑ <br /> _ f <br /> Character of sail to a depth of 3 feet: Sand(] Silt❑ Clay ❑ Peat j] Sandy Loam ❑ day Loam fl <br /> Hardpan❑ Adobe Fill-Material_: .........If yes,type............... ............ <br /> (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATIONe (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) <br /> i <br /> PACKAGE TREATMENT ( ] SEPTIC TANK 5#ze. �, ..: A........... Liquid Depth ....4................ <br /> Capacity,laIWZ-E44 Type . . . ... .... Material..No. Compartments ..9Z...............6 <br /> Distance to nearest: Well' ........Foundafion..//�:.......... Prop. line .... f...............r <br /> LEACHING LINE No. of Linei ...t,7:.:....':.:.'Le0dfh of ch line...... .......... Total Length ./.ka............. <br /> 'D' Box .... .... Type Filter,Material .. ....Depth Filter Material ... �f. �..... ...........•--.--•- In <br /> r <br /> Distance to nearest: Well i.(i. Foundations.../4 .. <br /> 10 �?Q:(fd1 ......... Property-Line . .................... <br /> SEEP F1Tfy <br /> Depth c;�4. ..... Diameter C . <br /> . . .. Number ..... ..... .. Rock Filled Ye <br /> 8� No 0 <br /> ..-•-- <br /> Water Table Depth:• ._.. .�t/.__................. .. ........Rock Size .... .. ............ J) <br /> .�.. — r LA <br /> Distance to nearestr Well .... ......Founstatlon .ra............. Prop. Line ........ -----.... <br /> REPAIR/ADDITION(Prov. Sanitation Permit :....._-•• ........... Date ............ <br /> ---..1 <br /> Septic Tank (Specify Requ#rementsl ......... .. -•- - -• ,_...�/..�....•...�j. ......................-............... <br /> �. <br /> Disposal Fieia (Specify Requirements) ......... _....__.................................................................� <br /> .......................................................................................................................................................................................................... <br /> .........---•.......................................••-----•---................ <br /> (Draw existing............................._...........n...re...v.......erse...N..de.....]._............. <br /> ....................... <br /> ....,............... <br /> and required addit[on a <br /> I hereby certify that I have,prepared this application and that the work will be done in 'accordance with San Joaquin <br /> County Ordinances, State Laws, and Mules and Regulations of the Sart .Ioaquin,Local Health District. Home owner at lice[- <br />' sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit Is Issued, I shall not employ any person In such manner <br /> as to become subject to Workman's Compensation laws of California." M"ARENdE'S SEPTIC•& SEWER SERVICE <br /> Signed •. Owner 263 So. Oro Stockton, Calif. 95205 <br /> 9 --------------•---................. .....----- ------..........._....... Ph.463-3209 <br /> Contractor's I.ic.#26717 <br /> By ....... ..: - ....... .. •-- .. . .. . . ...--••--•..................... Title <br /> (If other than owner) . <br /> R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ...... .... _..,.._.................................................................. DATE .... .. F..:. ........... <br /> BUILDINGPERMIT ISSUED ----•-----•.............................•--....------....------......I.............DATE .........._..._............................ <br />_ ADDITIONAL COMMENTS .. ..... ......................................................---..........-...........-••--.....---....-----.......- ................. <br /> ........................................ .. ....... . •._... ...... .... •.....................Ii.-.1....................... ... .. .................--........ ......-- .................. <br /> .... <br /> . ... ................................................. .. ........... <br /> final inspection by: .."-T­ <br /> . ..---•--•--•---•.........................---•--.......................Date ............ <br /> . <br /> ....... <br /> EH <br /> �K_­.....I..... <br /> 13 � "�' SAN JOAQUIN LOCAL HEALTH DISTRICT ' 8/7h 3 <br /> G/ <br />