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FOR OFFICE USE: ' <br /> APPLICATION FOR SANITATION PERMIT <br /> .......................��.. , . ... Permit No. 1­S.:.7 <br /> lComPI*t*in Triplicate) <br /> .................. ...... ............ This Permit Expires 1 Year From Date Issued Date Issued <br /> 47/1.0 :..... <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 Regulationse <br /> JOB ADDRESS/LOCATION .._..._._;- ,oia..ATito................................... .............. .. .............. CENSUS TRACT .......................... <br /> Owner's Name ....... Mr. Fell ..........Phone ....................... <br /> ............:.....�6-YbAuto.,...........----......_..................�........................... ............. <br /> Address .. City ..................Stockton <br /> .....................••------......._.................. <br /> f 'bb'6 f3oo er wr. Ser. 271539 1 65••2616 <br /> Contractor's Name ---------------- -------------------------- ------ __------ .........................License * ........................ Phone .............................. <br /> Installation will serve: Residentec]Apartment House 0 Commercial OTraller Court 0 <br /> Motel ❑Other -------•------------------------------- <br /> Number of living units:.. ._---.- Number of bedrooms 2._.........Garbage Grinder ............ Lot Size ..50..x_-11...................... <br /> Water Supply- Public System and name .....................Jaal-if.—W.at-er. Ser...-•--.....................:....................Private p <br /> Character of soil too depth of 3 feet: Sand o Silt❑ Clay o Peat❑ Sandy Loam ❑ Clay Loam <br /> Hardpan 0 Adobe Lei Fill Material?:?:........ if yes,type............... . <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be plated on reverse side.) <br /> NEW INSTALLATION: lNo septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK[ I Size................................................ 'Liquid Depth ......................... <br /> Capacity -------------------- Type .................... Material-----------........... No. Compartments <br /> Distance to nearest: Well ....._..............................Foundation ...................... Prop. Line ........................ <br /> LEACHING LINE [ ) No. of Lines ........................ Length of each line...........__.__............ Total Length ............................ <br /> 'D' Box ............ Type Filter Material ....................Depth Filter Material ............................................ <br /> Distance to nearest: Well ........................ Foundation :_-__-.:............... Property Line ........................ <br /> SEEPAGE PIT { ) Depth .................... Diameter ................ Number ----------------------- Rock Filled Yes 0 No <br /> Water Table Depth ----•--------•••..............•-•...._..--•.....Rock Size ............. .................. 0 <br /> Distance to nearest: Well ........................................Foundation .................... Prop. Line ...................... <br /> REPAIR/ADDITION(Prey. Sanitation Permit# .............................7......_...__. Date ..................................) <br /> Septic Tank (Specify'Requirements) ................................•---.........----.............................................................................I............... <br /> Disposal Field (Specify Requirements) ........... and...1.-33!...by..25.!...-pit................................... <br /> ------------------------•------- ............ -----•-----------•----- ----------•-------•-----.......•--•----------------........_......_...._...••----••--......................---....... <br /> ------------------------------------------------ ..........................................................._............................................................................................ <br /> (Drow 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 Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Nen* owner er licen- <br /> sed 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 /> Contraebbr <br /> By ------------ -- Title ....._._....... --......--- •--------.._....------••--•- <br /> loans) - <br /> ( other than owner) <br /> R DEP TMENT USE ONLY <br /> APPLICATION ACCEPTED BY .. .. . ... . ..........•-... .._._...._. _...._.._......... ..-......_._.__ .._................ DATE11--.-11!5.._7s�"---,-- <br /> BUILDiNG PERMIT ISSUED .....- .. .... ..............DATE .......................................... <br /> ADDITIONAL COMMENTS .: ----- .................................................... - <br /> •----- -- - ------------------------------------------------- ..._.........--- ...... ....._. ---•- .............................. ... ... <br /> ..---.__--. <br /> -------------------- -----•----• ------. ..------ ./ <br /> ....I.........I......_.,, ... <br /> ----------- - -1 <br /> Final Inspection by: ...i - Date .../� ..1. .�.�- ......--......... <br /> EH 13 2ll 1-68 lay. 54 SAN JOA UIN LOCAL HEALTH DISTRICT 8/7h 3M <br />