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.�4•f4RrOFFICE USE: x � -•' -FOR OFFICE-USE: ' <br /> ICATION FOR SANITATION PERMIT <br /> .... . <br /> - <br /> ;1 �� (Complete in Triplicate) Permit N o� <br /> -------------- --- ----- <br /> Date Issued-.6,-:;=.7f, <br /> `-- This Permit Expires 1 Year From Date Issued <br /> Application is hereb ade to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application i ode in compliance yiit�th County Ordinance No. 549 and xisting Rules and Regulations: <br /> J B ADDRESS/ OCATION. INTERSTATE 5 & EIGHT MILE ROAD see attached ma l i <br /> .. --•----- --- P1.CENSUS TRACT...'. ....... <br /> O e.,,..:W JOA-UIN..COUNTY,I DEPARTMENT OF PARKS & RECREATION <br /> Q -- ............... .Phone4�4-2tt8 <br /> Address- - ----- 22... ash. Weber.... ... ...-. City Stockton.. :Zip =95202- --- ------ <br /> Contracfor's Name = VALLEY MECHANICALS INC. i <br />> ......---License #--.3333- Phone....9-40031.:........... <br /> Installation will serve: Residence ❑ Apartment louse ❑ CommercialK] Trailer Court ❑ <br /> Motel A Other:.._OFFICE-- ------ j <br /> Number of living units:..O.............Number of bedrooms...(.-- Garbage Grinder. -Lot Size----.......:......... . .....- ---•.--.-- <br /> Water Supply: Public System and name--. -- ---- - ----- --------------------• -•---------- Private <br /> Character of soil to a depth of 3 feet: Sand ❑. Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ AdobeK 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 INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,} / :r <br /> PACKAGE TREATMENT [ I SEPTIC TANK Size -...- � � _. . _ + , <br /> ...X...���� ---- - . . ..................Liquid Depth. <br /> � --Type-G:ST.Mate-rial_.�,:.®AX,1ZF.J-V-No. Compartments----- (--------:-- OS4 <br /> Distance to nearest: Well-D-V Y -.-t-c�.®........ ..-- Foundotion--7- Prop. Line_...------ -''.....---,- <br /> LEACHING LINE D4 No. of Lines <br /> -----..-.-..Length of each line.----;- .--.---Total Length ...25...��.-- . <br /> , n 7 1 amu r0 i <br /> D' Box--.:...Type Filter Material- Rp.J �.. epth Filter Material..- ---------- ------•----...-.- ..-..--- ------ <br /> Distance to nearest: Well.. VAR--1cp._.Foundation..--- .-.- -..,,-Property Line.....F............ <br /> SEEPAGE PITp --_--- Rock Filled Yes ❑ ) No.❑ <br /> ( l De th..��.�.�Fneter-- - ----- --.Number---�----------------=- , <br /> Water Table Depth---------------- <br /> ..---- ..... .... ---------------Rock Size------------- ---------------------------------- <br /> Distance to nearest: Well------------- .........Foundation................... ......Prop. Line.. --.. <br /> REPAIR/ADDITION (Prev. Sanitation Permit#_...............:. . Date...................-........................... <br /> ) <br /> Septic Tank (Specify Requirements)-- --- <br /> Disposal Field (Specify Requirements)- ------------ --------- ........ <br /> ----------- ------------------------------ . ...... .... --......--- ....................... <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application qhd 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: gents <br /> 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 as <br /> to become subje to Workma 's Comp nsot. laws of California." <br /> Signed. �kk <br /> r C: � =� '�—i Owner , <br /> </... . . Tifle -- a. ----------- <br /> (if <br /> ........ .......... W. . <br /> ay- � 1 -.... . --:------ �� sem.. <br /> (if other tha ner} <br /> DEPARTMEN SE ONR Y v <br /> j- <br /> APPLICATION ACCEPTED B .. .DATE ._.... . <br /> . ----------------------- <br /> DIVISION OF LAND NUMBER............... . - ,i. <br /> --.....- ------------ ------ --------- DATE ------ ------ --- <br /> ADDITIONAL COMMENTS-- --..... . -- --....................... . <br /> ------- - ............--------------- ...._------ -------- ------------- - - ---- ------ ............... <br /> ­------------------- r <br /> ----- - .. . ---------------- •-------------- . --------- ----- <br /> -------- <br /> . . -- -- --�-Final Inspection by: <br /> n -_per 3 . -q! <br /> _. <br /> ....... ....... <br /> EN 1S"sb`"` F&S U677 fLEv.-7/76 SM <br /> t SAN JOAQUIN LOCAL HEALTH,DISTRICT v-�: <br />