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=FOR OFFICE USE: APPLICATION FOR7SANITATION PERMIT Permit No: .--- � ---� - ------`- ----------------------------------- (Complete in Triplicate) ------------ -- ------- --------•----------------------- s _ Date Issued + This Permit Expires 1 Yom,From Date Issued Application is�hereby made to the Sdn Joaquin Local*Health District fora permit to construct and install the work hereir. described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION -----------------------242 Car ent '• ------------------CENSUS TRACT ------------------------= P------ --r--Ad'----------------- -- owner'srName ._Ted__W_illAamS------------------------------------------------------------------ --- •-- Phone b2--�� Address k-----Sa ie-------------------- Cit Stockton ------------------------------------------------ Contractor%, .NameB:lackaz __'d'_ installation,w i l l_serve s`,Sep_tjp_ Tgj2 k-----------------------------.License # 268-9-r5 -------- Phone 4{3--'l0-4.8--------- �`; Residence] Apartment House'❑ Commercial []Trailer Court ;❑ r r '..Motel F-1 Other ----------------------------------------- Number of living units:-.,-, ------ Number of bedrooms ____ _.___Garbage Grinder Lot Size ---2__lCz'eI ---------------- ZI Water Supply: Public System and name ----------------------- -------------- ---------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam.E] Hardpan ❑ Adobe g Fill Material __.- ------- If yes, type ---------------------------- (Plot plan, showing size of lklocat.ion 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,) Ilk �r Size__ �'4"X6'X 10'_ Liquid Depth _--____---5_ - --------- PACKAGE TREATMENT [ ] SEPTIC TANK_'� Capacity ------ - Ype 4�--, 1600 T S Material_concre_te No. Compartments _---_-•- ------------- 20' Distance to nearest: WellSfl_!---------------- --;�ti-Foundation ------------------- Pro p. Line .- --------------- F LEACHINGLINE ] No. of Lines .........`�,fLength of each line-,,-___85°_________...... Total Length ---170'---------- .___. '2------------De"p th Filter, Material ------1-91'----------•-----�.------------- • 'D' Box _1__.-___ Type Filter Material Distance to nearest: Well ____ __ -- Foundation_:15 s---: -•=!Property Line _______ Q ---------- I 36-77-7 Rock Filled Yes M No ❑ SEEPAGE PIT [$ Depth ----2.5'--------- Diameter ---------�}-- -- Number ------------ ----- -- 1 Water Table Depth ------------99-0 -- ------------- ---Rock Size ---2n------------------ 100 -------------- �... Foundation 100°----- Prop. Line'=--- E Distance to nearest: Well ....3_00!------------------ REPAIR/ADDITION(Prev. Sanitation Permit# ----------=--------------------------------- Date __--------------------------------) P Septic Tank (Specify Requirements) ---------•1600---gall --------- -- ` t ----- ---------------------------------------i-------- j Disposal Field (Specify Requirements) ------------- P-it ----- ---------------------- Y f -----------------------------`-- f ' - - application an and that the work will se F - - - - that I have prepared this pp ------------------- ----- ----Y---------- -------'side) -�_,: v - ::. I hereby cern p p done-in accordance with San Joaquin [ County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed 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'bec a subject to Work an's Compensation laws of California." Signed -------------------- Owner Title __-------------__.__G3ntractia __---_.__-_.__----- By --- BJfBaa-ekar -------------------------------------------------------- (if ----------------------- (Iother r than owner) E Olt EPA NT SE ONLY t APPLICATION ACCEPTED By,(.,-",-- -------- -- - �---'. DATE BUILDING PERMIT ISSUED ----------- --- - ------_--- DATE - - - ------------------------------------ ADDITIONAL COMMENTS ------------- ---------- ---------------------=-------•------------------- , -i _ = ---------------------- ------------------ ------------------- -n-------------- ---- - ---------- t ---- ----------------------------------- 0 ---- - --------------- ' 0''1 "� rr. r --------- = = _--------------- - -- - pa Final Inspection by: _ ' - :, to -' SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M