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FOR OFFICE USE �a APPLICATION FOR SANITATION PERMIT <br /> Permit No ��.. �� <br /> (Complete in Triplicate) . <br /> `-C ,/� Date Issued <br /> Thb ar Permlt Expires 1 Yefrom Date Issued .................. <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ...... 28Q...E,... Ars].e� J.e........ <br /> .....................................................CENSUS TRACT ......... ................ <br /> Owner's Name Mrs K. Corbett <br /> ---------------------------------------••--•--...........,....................._....,.....................................Phone .............,...................... <br /> Address ... 372.. E E. Guernsey city Stockton <br /> ........._ .....................Ci .................................................. <br /> Contractor's Name ._RQ.ta_.RD.o.tes� �w�� •-fie ...................,...........License# .....2.7,3.:53.9.... Phone .46.5-.2.61.6........ <br /> Installation will serve: Residence Q Apartment House{,] Commercial❑Trailer Court ❑ <br /> Motel❑Other............................................ <br /> Number of living units:-_-2....... Number of beclroom3 ..3........Garbage Grinder -•-nQ Lot Size .....60-1....by...120-r........... <br /> Water Supply: Public System and name Calif.....Wat er..Ser..........._ ............................................Private❑ <br /> Character of soil to a depth of 3 feat: Sand b Slit❑ Clay Q Peat❑ Sandy Loam❑ Clay Loam Q <br /> Hardpan❑ Adobe a] Fill Material .R.©. ... If yes,type............... ............ Q.1{ <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,( <br /> PACKAGE TREATMENT ( l SEPTIC TANK{ ] Size................................................ liquid Depth ...................... <br /> Capadty -----•--•--•. ...... Type -------------------- Material...................... No. Compartments ...................... <br /> Distance to nearest: Well ....................................Foundation ...................... Prop. Line ...................... <br /> LEACHING LINE ( j No. of Lines ........................ Length of eachline............................. Total Length ............................ <br /> 'D' Box ............ Type Filter Material ....................Depth Filter Material ............................................ <br /> Distance to nearest: Well ........................ Foundation ........................ Property Line ........................ <br /> SEEPAGE PIT O Depth .................... Diameter ................ Number ........._... .............. Rack Filled Yes ❑ No Q <br /> WaterTable Depth ••---•-•........................................Rock Size ................................ <br /> Distance to nearest:Well ........................................Foundation .................... Prop. Line ...................... <br /> REPAIR/ADDITION!Prov. Sanitation Permit# ............................................ Date .................................. <br /> Septic Tank (Specify Requirements) &dd... ....-a-aeh..... -- —3-331.-.by...2:5.t...pit................ <br /> Disposal Field (Specify Requirements) ...to._.existing__system_____ ___ __ _ <br /> -----------------•---•--•.................. <br /> .......................................................... •--••---------......--••--••------..............---.........•..--- ........................................................................- <br /> -••---•-•-• ..................•--••----•••....... ............................ ............................-................................................. .......................................... <br /> (Draw existing and required addition on reverse side) <br /> 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health:District. Home owner or liae- <br /> sod agents 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 <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ----------•--•- _......... _ Owner <br /> Joe White Contractor <br /> By ----- ..... ................................. Title ...... .................... ---------- ................... <br /> (If other than owner) <br /> R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - •_.------------ <br /> -- ---- ... .......... DATE - .�...r. (°------------- <br /> BUILDING PERMIT ISSUED ...... ... . ._ ................................................ --............- ........DATE - ...... ----••................... <br /> ADDITIONAL COMMENTS ---- ----- --- -•. -•-._......••••-••--...•--.......-•••................-.-...... - <br /> f _ •• •--•-•--•..................•-----....._........•••--- ...... -• ........._.........-----------......... .............. <br /> .............. -----------------­­------- -- ---- ­- ...•-- - --_..--•------•------......-.-......... ...........--------..-...... •.. ------...................................... <br /> ... <br /> - ----------------------------------- - - ..... .... ......................................................:...... --•------ ....... ........ ........................ <br /> Final Inspection by: .. / Date ... 7� ... <br /> EH 13 241-68 `' SAID!' JOAQUIN LOCAL HEALTH DISTRICT 8/7b 3M <br />