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FOR OFF'rCE USE:, FOR OFFICE USE: <br /> .= APPLICATION FOR SANITATION PERMIT <br /> �. <br /> ----- ------ -- ----- ... .. ..... - <br /> (Complete in Triplicate} Permit No...7o4P.5 <br /> Date Issued.ZP..77.6..-?, <br /> ........... ..........' - 151 <br /> This Permit Expires I Year From Date Issued <br /> Application is hereby made to.the San Joaquin Local Health District for a permit to construct and install the work herein described, <br /> This application is made in compliance with Cdunty Ordinance'No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION.. -.. --- - 1 - <br /> `c �... - ----------- ---------------------- -.-..CENSUS TRACT-.---------------- -- <br /> Owner's Name..,. ... ..... .. <br /> -- .... <br /> Address----- -..... ,. /- _. - Cit one- Zi <br /> s a Y Pa,� c "- <br /> Contractor's Name � <br /> ..R-¢- -- --.... -P--� '�a.I:icense� - <br /> Installation will serve: Residence Apartment House Commercial Trailer Court ❑ <br /> Mofel ❑ Other--.. --......... <br /> Number of living units:...cp........Number of bedrooms.. -Garbage Grind&r._'!.._Lot Size... fj AZU~............ <br /> Water Supply: Public System and name.- ..- ' <br /> ---- <br /> __-_--,-._-----private 1­11Character of soil 'to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe)< F01 Material . .-- - If yes, type <br /> (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) r�qq <br /> NEW INSTALLATION: (No septic tank or seepage pit perrrytted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK [ ] __..-.. - --------------Liquid Depth.-•...............-- VWWW� <br /> -� <br /> Capacity....... .......------Type------ ...Material---- ----------------------No. Compartments............... ...... <br /> Di"stance to nearest: Welf"................... .. ........ ...:,.:-^-Foundation.--------- - --- Prop. Line-...........- <br /> LEACHING LINE No. of Lines <br /> - --�.............------Length of each line....... .-. .-._. .............. Total Length 0 <br /> 'D' Box-.-. rC <br /> '�` Type Filter Materia€.- - _, .-..Depth Filter Material.....lr�.. ... ... ----------- .. ------------_...-.. <br /> Distance to nearest: Well_-.)t&w,Xa �®..Foundation.-../ .-------- --- Property LineP <br /> ��C. // ---- <br /> � s��"' �-•--------�-------�-- --- <br /> SEEPAGE PIT Depth �"".-Diameter. /..-..Number--- ._f--------------- Rock Filled Yes No.U� <br /> Water Table Depth--------��'-Q. .'........- ...............-Rock Size.............. . . --• <br /> ---------- -•------- - -- <br /> Distance to nearest: Wel€. -ZA. ...........Foundation---- ....-..-....Prop. Line..-..r ..._- .-.....-... <br /> REPAIR/ADDITION {Prev. Sanitation Permit#----- -------------------- ----------Date.......----------------. ------ - <br /> Septic Tank (Specify Requirementsl.... <br /> r --------.-- ' <br /> --------• --------------- <br /> Disposal <br /> -------------Dis osal Field (Specify Requirements)..... --. -- - - ---- — <br /> Lf <br /> . ... .. • <br /> ------------------ -------------------------- -------------------------------- -- -- --- -- ----------------------- ------ <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District, Home owner or licensed agents <br /> signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, t shall not employ any person in such manner as <br /> to become subject to Workman's Compensation laws of California." <br /> Signed....-/ .. ------ - ------ - --- --- --- _ wner CLAREN''CE'S SEPTIC & SE'iER SERVICE <br /> Title. <br /> 2�,; c� G;Cr <br /> BY <br /> �- ------ ..... -- r....�tl.:i�:-:�U� <br /> Of other than o er) i P <br /> FOR DEPARTMENT USE ONLY <br /> OF 4 <br /> APPLICATION ACCEPTED BY------------- -- --- DATE .... <br /> DIVISION OF LAND NUMBER _ ......... ............ ------DATE.-............................. ....- <br /> ADDITIONAL COMMENTS....................- -.-..........-- -- <br /> ...- ` ---- ------------ <br /> Final Inspection by:. .-r .... �ti� Date...t!sr..��.. .. q <br /> EK 13 24 SAN J0AQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7176 3M <br />