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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ._..._......................................... (Complete in Triplicate) ............. Date Issued .!�02/.7.S . ............. 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: ..'... ....... ....... .....CENSU5 TRACT ..-..-..............------ JOB ADDRESS/LO TION ,..... • ..... .... .G� . .. ... . Owner's Namec r••- •••• Q11�Y. ?........aJ•' Phone ............. . ................... Address [ ��- ` `..._ :. �'�-R ... :....... City ...... .......... ............ Contractor's Name ......... . .:'� ......- .......License # .. Phone .............................. Installation will serve: Residence portment House 0 Commercial []Trailer Court j_] Motel ❑Other ............................................ Number of living units:............ Number of bedrooms ............Garbage Grinder Lot Size .................. .......... Water Supply: Public System and name ....... .. . .............. .............Private Character of soil to a depth of 3 feet: Sand D Silt❑ Cioy ❑ Peat❑ Sandy Loam 0 Clay Loam 0 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 208 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK{ ] Size................................................................................. Liquid Depth -:........................ Capacity ..................... Type .................... Material...................... No. Compartments Distance to nearest: Well ..Foundation ......... Prop.Line ......................�j LEACHING LINE [ j ........... len ... Total Length ........................ J No. of lines -------•----- Length of each line:......................... g 'D' Box Type Filter Material Depth Filter Material ............................................J Distance to nearest: Well .... Foundation ....... Property line ........................ SEEPAGE PIT [ j Depth Diameter Number ............................ Rock Filled Yea Q No �7 Water Table Depth .........Rock Size ................................ Distance to nearest: Wel{ ..............Foundation ...... Prop. Line ....................... REPAIR/ADDITION Prev. Sanitation Permit# Date ..................................) �p Septic Tank (Specify Requirements) .................................P........ C .....•--......................................................_.......- Disposal Field (Specify Requirements) --.-t[1Q ..... � .... ......................_.............--••-- `' -�. 2.. -� ...... ..........------- ......... ...........:... " (Draw etcisting and required addition on reverse side) 1 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 {icon• sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." CORTOPASSI FARMS, INC. Signed ...................................... Owner _ 11292 No.Alpine Road By........P��..... Stockton,•Californis••95205 ............... . Title . ............. . other than owner R DEPARTMFAT USE ONLY APPLICATION ACCEPTED BY .. ... . .... .........• ....-•... DATE .... ....-........-.75............ ...... .: - . BUILDING PERMIT ISSUED ................................................DATE ........................................... ADDITIONALCOMMENTS •..........................:....................................................... ....................... ............. Date '••••-•-•..._.. Final Inspection by: .......... .......A SAN JOAQUIN LOCAL HEALTH DISTRICT L3 24 7-/'72 3 M E. H. 1-'68 Rev. 5M ---