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FOR OFFICE USE: APPLICATION FOR SANITATION PERMITS C Z (Complete In Triplicate) Permit No. ..................... ..._..---............_........I.......................... l�-75' This Permit Expires 1 Year From Dab Issued 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: JOB ADDRESS/LOCATION .....fi767_.Walfinger-..RcLad._Stockton..••E•Raber•ts•••I•61NSUS TRACT .......................... Owner's Name _.Dame...a0hn--- ......... .......Phone --•--------------•-.............................- .4,6.5-.5&83.............. Address ... .. P ..O .Box._.1.4.6.1---- --------•••--- ......... ..................City ..Stocktoi------...............---.............I................ Contractor's Name ----- ----------------------------------------------------------------------------------License # .......•................ Phone .............................. Installation will serve: Residence[3 Apartment House Commercial 1--)Trailer Court fl Motel ❑Other............................................ Number of living units.---,I------ Number of bedrooms .._4......_Garbage Grinder .....1.... Lot Size .......35...&cXe.s................. Water Supply: Public System and name ..............................................---•-----........---------•-.....................................Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam fl Clay Loam Hardpan❑ Adobe 0 Fill Material ............ If yes,type ............... ............ (Plot plan, showing size of lot, location 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,) PACKAGE TREATMENT f ] SEPTIC TANK[4 Siz(84.7W--- ...6-±-4-!!g----- Liquid Depth ...-4.8................. Capacity _16.0.0...ga1Type .................... Material-9o?'?9._........ No. Compartments __.2............ Distance to nearest: Well __420.1........................Foundation ....1D.!............ Prop. Line ........4ao.'.... .J LEACHING LINE f ] No. of Lines ....... .......... Length of each line......... .............. Total Length 0_0..........I........ ,6 'D' Box ..1....... Type Filter Material ._7.-2-.L2_"-Depth .Filter Materia! .19"....................................J Distance to nearest: Well _.3.�.A'............ Foundation ---2.0'...... ...._.... Property Line .......2.94-....... SEEPAGE PIT [ ) Depth ------ Diameter ................ Number --- --_----..--.----•-- Rock Filled Yes ❑ No C Water Table Depth ----- ..........................................Rock Size ................................ 4 # Distance to nearest: Well .............................. .. Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------------------_-------- Date ..................................I # Septic Tank {Specify Requirements) Disposal Field (Specify Requirements) ---------------------------•-- ....... .............---._---___------ .....................................................M ---------- - -- ---- -- - - ------- -• - ---- I Draw existing and required addition on reverse side) 1 hereby certify that 1 have prepared this application and that the work will be done In accordance with Son Joaquin. County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health:Dlstrict. Hance 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 becomejol4ect Wc sation laws of California. Signed ...... ----- - -------- ------..._-__...........------------ Owner By ----- ------ Title -... ------- ---------- Ilf other than owner) �j F DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY---•- Ca- r ----- ----------- DATE . -?- �--7-- ............ BUILDINGPERMIT ISSUED ...---_------------------ - ••------------------------------ ----------- -------- ---------- ------ DATE .......... ------------------- ADDITIONAL COMMENTS --------- ------------•------- --------•- ---------------------------------•------------- .._ .. --- ----------.....-- ----------------•-----•••-- •-••--- ------.............................................. Final Inspection by: .....--•----------------.__....---...._..------..._....----------... -•-•----....Date ms..... ... . �/A .. �-.`--_------ lei 13 24 1-68 Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT 3M