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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> �i <br /> ------------ ----- I- Permit No-. 73-._. <br /> (Complete in Triplicate) <br /> -------•- ��� <br /> ' This Permit Expires 1 Year From Date Issued Date Issued _4 �3.. <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 .----4343--NoAshley--Ln, -- --- - ----- ---CENSUS TRACT ----------------------- <br /> Owner's Name --_LStockton--Wa er_loQ_.Gun..-.&.-B_a.cai---C-1ub---------------------------------Phone ..g_Jl._©-323...........-- <br /> Address ;------Same--------------------------------------------------------------------------- ------ City .....Stk32;----------------------------------------------------------- <br /> Contractor's Name -- - - kard;s__Sept e_Tank-_Co,_____-__________-License # 26.8951.-.__- Phone _..._-4 _3L.-n.4.-.- <br /> Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court !❑ <br /> Motel ❑Other ------------------------------------------- <br /> Number of living units:-----1----- Number of bedrooms _._1-----Garbage Grinder ------------ Lot Size -5_Aa es----------------_------ <br /> Water Supply: Public System and name ----------------------•-----------------------------------------------------------------•---------------------Private ] <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam :❑ <br /> Hardpan ❑ Adobe ® Fill Material ------------ If yes, type __._-.-__------------------ <br /> (Plot plan, showing site 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 [ ] SEPTIC TANK'{ ] Size-----------------------------------.------------ Liquid Depth _......---__---......__. W <br /> Capacity -------------------- Type -------------------- Material------- ---- No. Compartments ...................... <br /> Distance to nearest: Well _____________________-.___________Foundation ---------------------- Prop. Line -_-- ................. <br /> LEACHING LINE $] No. of Lines ----.---}-------------- Length of each line-------40_'______-_--_ Total Length -401---_................ <br /> 'D' Box ___1______ Type Filter Material ------2_"__._-__-_.Depth Filter Material ----1_g'!________________________ _______ <br /> Distance to nearest: Well ---------1O.Qs._._- Foundation -2-01--------------- Property Line 100 <br /> r <br /> SEEPAGE PIT Depth 2 r 3...� Number ________1_._..-__-___. Rock Filled Yes No <br /> fel p -- Diameter <br /> Water Table Depth -------------9Q-------------------------------Rock Size ---------211------------------ <br /> Distance to nearest: Well _______1.x-0 x__-.__-_-- .,_...Foundation ------201.....__ Prop. Line ..100 1W......... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# .----.- ------------------------------------- Date -_.__-..-..--.-_.-.----_------_.__) <br /> SepticTank (Specify Requirements) ----------------------------- --------------------------------------------------- --------------------------------------------------- .--- ` <br /> Disposal Field (Specify Requirements) --------40-!---Ileac-h--Ll-ne--&---P1t---331r---X-X-25-t------------------------------ --------------- <br /> ------------------ ---------------------------------------------------------------------------------------------------------------------------- <br /> (Draw existing and required addition on reverse side) <br /> I 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 licen- <br /> sed agents signature certifies the following: <br /> "1 certify that in the performance of the work for which this permit is issued, l shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed - -------------------------------- -------------------------- Owner <br /> BY ------ Title -------C-Qntrac_tor-------------------------------------- <br /> ------------- <br /> ` . ` <br /> (If other than owner) <br /> FOR PJPMWNT USE ONLY <br /> APPLICATION ACCEPTEDBY _.- '� _, ___-__.... . ....... .. DATE <br /> BUILDING PERMIT ISSUED ------ ---------- ---------------------------------------DATE ------------------------------------------ <br /> ADDITIONAL COMMENTS ------ <br /> 7->------------ ------t-7------ - -------------------------------------------------- ------------------------------------------------- ------------------------------------------ <br /> --------------- - --------- <br /> 0 --- ---------- ---- - - ------------------------------------------------------------------------------------------------------------------------ -- <br /> -------------------------------------- -- -- -- -- -- - -- --------------------------------------------------------------------------------------------------------------------------------=------- <br /> Final Inspection by: Date — ---------- <br /> - l N JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />