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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------------- - - ---- (Complete in Triplicate) Permit No. --- ------ ---- /�_-(� ------ This This Permit Expires 1 Year From Date Issued Date Issued-__-l.._:__� 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 3423 Sop eB'* Street ----------------------CENSUS TRACT --------------- ----------- ___ _______ Donald W. Brown 948-3331 Owner's Name - - ------- ------- ---- Phone --- ----- ----- ------- - --- --- -- -------- - ----------------- ------- ---------------------- Address ___-______-_____________same Stockton -------------------- ----------------------------------------------- -------------------- -------- -------• . City ---------------------- ------------- - -------- ------- Contractor's Name Day_&_N ght__$ewag ---I2 9po-aa1__C9._________________License # _9 __ Phone 466_"'3811 Installation will serve: ResidenceZ4Apartment House❑ Commercial ❑Trailer Court ❑ Motel ❑Other - - - Number of living units:---A----- Number of bedrooms -3-------- Grinder _________ Lot Size _5-ACres Water Supply: Public System and name ------------------- ---------------- - ----------------- ----------------------------- ---------------------Private gXX Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe ME 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,) Mr,, PACKAGE TREATMENT [ ] SEPTIC TANK[ ) Size------------------------------------------------__________________-__ Liquid Depth -------------------------- �J Capacity --------- ---------- Type -------------------- Material__..----------------__ No. Compartments Distance to nearest: Well ____________________________________Foundation __._ ----------------- Prop. Line ___-___._.__ LEACHING LINE [ I No. of Lines __---------------------- Leng _ line---------------------------- Total Length 'D' Box _____- Type Filter Material __ _ __ . _____-Depth Filter Material --_________-___ _ Distance to nearest: Well ----------- «�Um`oerndation ------------------------ Property Line - - - -------------•--- SEEPAGE PIT - ( ] Depth -'------------------ Diameter ---__-__- ___.---------------------- Rock Filled Yes ❑ No i❑ Water Table Depth ---------------- -------------------------------Rock Size -------------------------_------ Distance to nearest: Well _____________________________________Foundation ----- -------------- Prop. Line -________-_____..__.__ REPAIR/ADDITION(Prev. Sanitation Permit# _______ ------------------------------------ Date ___-__________--____-_________-) Septic Tank (Specify Requirements) -------Insta-11' '1200--gal.--Conere-ts'-"oegttc--�'ank__�gplacing--defuna-t-_.•- Disposal Field (Specify Requirements) -_redwooank: Connecting tank to existing drainage-__-and________ --------------a- dding---60_-l.in--f t__new-_leaching----dr_ain.------------------------------------------------------------------------------------------------------ -------------- ------------------------ --- - -------------- . ---------------------------------------- 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 Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "1 certify that in the performance of the work for which this per it is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation la s of Cali rnia." Signed ___-DAY-_& NIGHT Sewage D' sal oCo. - - - - ----------------- --------- ----- ------------- -- By -------------------------------------------------- ---------- Title . -- - ---------- (I other than owner) ------ ------- -- - ----------------- A MENT USE ONLY APPLICATION ACCEPTED BY ------- ---------- 1 --- --------------------'----------------------------------. DATE - 9- --------------------------------------------- BUILDING PERMIT ISSUED ________________ _ ----------------- ADDITIONAL COMMENTS ______ - - - DATE - - ---------------------------- -- ----------------------------------------------- - -------------- - ----- -� - ------------------------------ ------------------------------------------------------------------- Final Ins ection b -- Y - --- ---- -------------------------------- - ---------- - ------------------Date JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M