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FOR OFFICE USE: APPLICATION '-OR SANITATION PERMIT This Permit Expires 1 Year From Date Issued b' igr• - ---------------------------------- . Permit No. __73-3�6-- ------ --- ---------------- '�` �------------------- - (Cgmplete in Triplicate) 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 .-.---------E�187--N-+--Alharubr_aj,--3to-ektQiI------------------------------------CENSUS TRACT -------------------------- Owner's Name -Richard A Rasmussen_---_-_---------------------------- -------------------Phone _47A4.5 $_ 0 - Address --------------8618 Acapulco--i 4y--•----------------------- - ------ City ----------- tockton------------------------------------------------ Contractor's Name -------- _ Ir I'hller _ ; License #271__582--------- Phone W__14 ............. Installation will serve: Residence ER Apartment House❑ Commercial❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number of living units:---1------- Number of bedrooms -3 1_______Garbage Grinder NO Lot Size --x j 5 0- 3'50 Water Supply: Public System and name --------------------------------------------------------------------------------- ----------------------------Private l Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe [4 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,) J PACKAGE TREATMENT [ I SEPTIC TANK'[ Size------------- -20.Q_.9al--5x5x9___ Liquid Depth _5t_________________'_-- J Capacity l?53Q----------- Type Precast----- Material----cone--------- No. Compartments _ -2,___.._ ....� Distance to nearest: Well ------------5Q-------------------Foundation ...10------------- Prop. Line _ 14!:. .... LEACHING LINE [ No. of Lines _.------2------------ Length of each line----------1--------------- Total Length ],_5Q.--------------------- 'D' Boxy0.5___._ Type"FiftrMaterial lix. 2imckDepth Filter Material -----19-- ___________________________� Distance to nearest: Well _501_---________-_ Foundation 1Q!°_________________ Property Line _____5t.- SEEPAGE PIT J Depth -----25-t Diameter -33-11-------- Number ----2---.----Ak-------- Rock Filled Yes ® No i❑? Water Table Depth Rock Size ljpc2i_____________________ Distance to nearest: Well ----------100------------_--------Foundation .................... Prop. Line ---58............... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------.------) SepticTank (Specify Requirements) --- -------------------------------------------------------------------------------------------------------__-------------------------•-- DisposalField (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 Joaa County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or li 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 m as to becomes blect mampensation laws of California." Signed ---- ------ - `------4----------------------------------------------- Owner By --------------_-------------------------------- ----- ------------------------------------- Title ------------------------------------ ------- -------- ------------------ (If other than owner) FW DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - _ _--_. DATE . f C-- BUILDING PERMIT ISSUED ----- -- ------- ----- - l - ----- -----DATE- _�--- --------------------- ADDITIONAL - --- --- -- ADDITIONALCOMMENTS ------------------- ------------------------------------------------------------ -------__----------------- --------------------=-------------- -------------------------------------------------------------------------------------------------------------- -----#---------- --------------------------------------------------------- ---------------------------------- ---------------------------------- - ---------------- --------------------------------------------- Final Inspection by: _____________________________ ! Date __.----------- _ SAN JOAQUIN LOC/KL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M