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FOR OFFICE USE: FOR OFFICt USt: APPLICATION FOR SANITATION PERMIT ��JJ��jj TF Permit No.....1...l.. .. _� �(Complete in Triplicate) ' 1..-------------------- --- -- ----- -------•---- JUN 1 - 7979 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 com lionce with County Ordinance No. 549 and exi ' JOB ADDRESS/LOCATION ��t-.#1.2._Oak_C.reek._#-1..._AGQrn.-.Cour--. � ?� __ ......CENSUS TRACT Owner's Name.._RObert Hi l brand Phone. 86 6567 Wihliamsburg - ... Address- ------------- __ _. ... - - City Stockton Zip�5207_...-...._.-... Contractor's Name.-._RQb-ert__Hil-debra►ld................ ....... ........License #32.1:4.20---------.--- .Phone-466-5A$6.---------- -- Installation will serve: Residence [� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other-------------- --------------....--.... Number of living units:-----------_....Number of bedrooms_3._-- Garbage Grinder.....1......Lot Size-------- 2_ ac... . _ .:-_- Water Supply: Public System and name---------.---_--------------......._.---------- ............................................... _....------------------..Private [�y Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe)] 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 [X] SEPTIC TANK [A Size_.-..1.600 -gal-----------------------------------.-Liquid Depth.........--------.......... Capacity.:1600. gal_._Type----------------__-..Matwial__.concrete _..:No. Compartments-----•-.:--_-•--.. Distance to nearest: Well... _ ...... Foundation...__._. Prop. Line-..... Q............... LEACHING LINE [X] No. of Lines _:_..2....................Length of/each line.......g5_,_..............Total Length_. .� ....:. -------- 'D' Box`l.K5.. . Type Filter Material.."2.-Z.... Depth Filter Material---............1-.`.._._.............-....... ........... .-_. r � I Distance to nearest: WellFoundation.-_... 5...............Property Line.....SP_..........._..._...... SEEPAGE PIT ' .. -___---.--. Rock Filled Yes No [X] Depth_..25.-_._.Diameter.__36--_.__--...Number.._-_2______________ [� ❑ Water Table Depth------------------_----------- - -------- ----••---.Rock Size.--- �'..Z��L....----- -----•--------• - _ r � Distance to nearest: Well._....--4Q____....__.---------------Foundation...... ..___.__.Prop, Line--- . REPAIR/ADDITION (Prev. Sanitation Permit#__._..._...................____.. ..............,Date....._......__.-._._-__._..__......_-._-.__) Septic Tank (Specify Requirements)------ - ---- -•-------_ ----------- ---------------- ------ -------------------- ------ ---------- Disposal Field (Specify Requirements) ------ -----•-- _----------------- -----•---•--•--------_--- -- ------ -- --- ---------------------------------------- ---................................ ..... ...............------..........-_-----•--- ---•----•-•--------------------- ---- ----- - ------- -------- ----•---•--------------------------------- ------••----------- .......... -------------- ------ --------•--- --...-- ............ (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 Joaquin County Ordinances, State laws, and Rules and Regulations of the San Joaquin Local Health District, Home owner or licensed agents signature certifies the following: "I certify that in th orm nce of a work for which this permit is issued, I shall not employ any person in such manner as to become subj o ma sation laws of California." ,tA Signed-------- - --- ---- - - . ...._Owner By...... ------------- --- - -- .. ........ Title--- .._.... ------• ---------- --------------------------------- (if other than owner) FOIR DEPA E T E ONLY APPLICATION ACCEPTED BY-------- -.. - ....... .DATE ------to. - �P_ _ -7-- •----- --- - ---- - --------- ---- ----------- DIVISION OF LAND NUMBER.-- --- _5.x.7. ". •• _DATE - ------- --- --- --------- ADDITIONAL COMMENTS._............... ----------- _ ._ -----._.. -------------------- -- -----...---- -- ---- ------------- ............ ----------------- ----- --- ------------............... ............. ---------------- ---------- -- -. ... - -------------------- ------- ---- -- - -----------..............•................... -- -- ------. ----------------------...._.--- ----------- ............. .... -- -- ----- ---------------- -- _..... -- ` -------------•---•------------- ----- -------------- -------------------------- Final Inspection by: .-._ . --------- - ------Date. .....g'c��- ] q --- ----- EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/76 3M