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FOROFFICEUSE: APPLICATION FOR SANITATION PERMIT Permit No; ------------------ fCumplet�in Triplicate) -- ---------- ------ — - �..� Date Issued ____ _____________ -_ _- --:� _ ________-___ ' 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: OB AbDRESS/LOCATION -----------------._- 3990North WiJ_son Way? Stockton _CENSUS TRACT ---------------------_- - ---------------------------------------------W #� ___ f 5 Owner's Name;-----------------•- M�.�S--A.__Paxx'�:�h-----------------------------------------------------1-------------------Phone --�56--4607---------- ' Address.-- ----------------- -------------- ]28__F�as# Mn4 '- 1Y4- -_Sc? Q �. i1itQIla1----------------- --------------------------_-------•------ Contractor's Name ------ -------------- .-_Pax'x'ash_ C__Svns,__Tnc.-------------License # ------1005U----- Phone _466_9!W----------- Installation will serve: Residence ❑ Apartment House-E] Commercial ]Trailer Court ❑ Motel ❑ Other -------------------------------------------- Number of living units------------- Number of bedrooms ------------Garbage Grinder ------------ Lot Size ----__--------_-------_--_-------_-.___-_- Water Supply: Public System and name -------------------------------------------- --------------- ------------------------------------------------Private f] Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay: ❑ Peat❑ Sandy Loam '❑ Clay Loam ❑ Hardpan ❑ Adobe-E] Fill Material -- Yes_ If yes, type ---Sandy-_C14Y'3-- " {Plot plan, showing size of lot, location of system in relation to wells, buildings, etcmust be placed on reverse side.) "y 1 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ I SEPTIC TANK'[* Size---t_16x8------------------ ------------ Liquid Depth -------52n--.-_-_--.__ Capacity e precas�___ Material...concrete_ No. Compartments ----TWQ_:._..._.... P Y ---1-- - -2QQ---_--- Type Distance to nearest: Well --------- ©T-------------------_-Foundation -- 10,---------- Prop. Line ---P0_1 LINE [x] No. of Lines -----ane------------ Length of each line-------HiQ'--------------- Total Length -----6at----------------- 'D' Box :Pr1P99#ype Filter Material ---rVrggKDepth Filter Material --------19...... ------------------_---- Distance -_-_-_Distance to nearest: Well ----- 0t----_-_----Foundation ---20T_---_-----_- Property Line _1001.- - SEEPAGE PIT PC] Depth __251------------ Diameter 33'_'_--____-_ Number one---------------_--_- Rock Filled Yes-b No 1❑ Water Table Depth------------------------------------------------- 1 _----_60_'_ -_ -_-__-Rock Size --- ---------------------- Water -------------------------- - ------------ Distance to'nearest: Well ---- 150'-----_-----1 ___--_-_-__Foundation _8d1_---------_- Prop. Line ...75,_.__. . _. i REPAIR/ADDITION(Prev. Sanitation Permit# -------_----------------------------------- Date ----------------------------------1 SepticTank (Specify Requirements) ------------- ------------------- ------------------------------------------- ----------:-------------•-------------------------------- i DisposalField (Specify Requirements) ------------------------------------------------------ -------------------------------------------------------- -------------------------------------------------------------------------- --------------------- � w - ---------f-- -- - ------------------------------------------------------ --------------------- ------------------------------------'- -- -------- s' l t (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 Joaqui 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 become subject to Workman's Compensation laws of California." Signed ---------------Milos.-A-._Parraslh.-�- - s----------- - -- n ,.• '''' - Owner - ---------. Title --- --------------------------------- ----------------------------------BY -------------- �tan ` ------ f ner) FOR DEPAitTMENT USE ONLY,d „ e r APPLICATION ACCEPTED BY .-----------'----'-------------- 5� --------------- `�--------------------- DATE _3 --------q------------------ BUILDING PERMIT ISSUED _---------------------------------------------------------------------- ----DATE ------------------------------------------- ADDITIONAL COMMENTS ------------- ----------------------------------------- - = ::/ ------------------------------------------------- ----------------- -- ------------------------------- - --------------------------------- ---- ----------------------------------------------------------------------------------- t ---- - Final Inspection b - -�~ - Date ------------- --- ------------------------------ ------- -------- --- -- - - P Y ��--- --- = SAN JOAQUIN L00�:i,`i71STRICT, E. H. 9 1-'68 Rev. 5M,