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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT •r ............. 0 .......................... _�. (Complete in Triplicate) Permit No. ..7T ..............••.......... .................. ...................... .............. This Permit Expires 1 Year From Date Issued 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: 352 S. Olive-Stockton JOB ADDRESS/LOCATION ......................................................................CENSUS TRACT .......................... Owner's Name .0111.e._?td:1li.ams.................................................. •-••................Phone ••. ............................... Address --932 Avalon Stockton City .............................................................••-••.......... Contractor's Nome ........... ---.License # ... Phone 4� 5-2616 Rataaoer Ser: 271539 •..... Installation will serve: Residence [ Apartment House❑ Commercial ❑Troller Court ❑ Motel ❑Other ............................................ Number of living units:............ Number of bedrooms .......Garbage Grinder yeS_.._. Lot Size .50 x 118.95. Water Supply: Public System and name ---------0-A-•i f-.--- -at-er-• S r-�-----------•-----------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan [ Adobe E] Fill Material ... If yes, type ............................ (Plot plan, showing size of lot, location ofsystem 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,) PACKAGE "TREATMENT [ ] SEPTIC TANKI.] Size.....- L..X.._ .t___x..9 t__-._____-- Liquid Depth ..._ t 5 ��. ............... Capacity -3200......... TypeP?�cs�...... Material.. No. Compartments 2.................... Distance to nearest: We 5} ........................Foundation ... �............. Prop. Line LEACHING LINE k] No. of Lines ..A......l__---__----- length of each line._.___-lUp.t............ Total Length ...1-04D.t............... rr Bo�aer'o � .... Type Filter Material ck..........Depth Filter Material .lg...................................... N. Distance to nearest: Well n/a:._...36r.... Foundation ...1�................ Property Line .....................__. _----~ SEEPAGE PIT [�) Depth 25-J....__..__.__. Diameter xzr......_ Number ________________ '`:_... k Fille Yes ? No ❑ Water Table Depth .---.._._A.....:Z8..................... ...Rock Size ---_-� .._ley... f_.... n Distance to nearest: Well ... 101 ... . Prop. Line 5 r a REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..................................I SepticTank (Specify Requirements) ................... ................................... .....................•......................................-................. DisposalField {Specify Requirements) ................... ................................... ........................................___---------.............. ........................................................ .............................. ....-.................................................................................... ........ (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. "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 su ject WWorkKn's Compensation laws of California." 5gned . --------f ------- •. Owner By ................. . ....... Title...............0on.t�aet•o3........................ ----- f other than owner) FOR DEPARTMENT SE ONLY APPLICA ON ACCEPTED BY ........�-- -- -----------•--••---•- DATE ..p .-�Q��Y.•• BUILDS PERMIT ISSUED ^...........:.. --....._...DA ------ ADDITIONAL MMENTS �� ATE .4'_ .c. , GY.Lt 7- l'�J .�.i lei _.......... ........................ --- .. .. ... . ... - - .. ... ........ . --- -- ------ ------ ------ Final Inspection by Date .. ...... ... ,7 ............. SAN JOAQUIN LOCAL HEALTH DISTRICT 13 24 7172 3 ,K ..E. H. _ i-�i8_Rev. 5M