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4 N r / FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT / ld=Q -------- -- o-- -------------------- ---------- (Complete in Triplicate] Permit N -------- --- ------------------------------------ -� .__�____. _- - ------------_-------------------------------_---------- 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: 4 JOB ADDRESS/LOCATION .--.- 808--$p*--QUYe- St.--------------S-taaktan_.r° � CENSUS TRACT Owner's Name OTIS BROOKS _ 982»!�4 --------- - ------------------------------------------------------------------------- = ------.._Phone -- -----------�:..- Address -------------------- ---------•- Cit Sto-caktan----------------------------------------------- Contractor's Name - JJ. A• PA RISH-- -SOIT �--- XC.--------------- .License # ------ ------------------ Phone __466"96Il7.......... Installation will serve: Residence DyApartment House❑ Commercial.'❑Trailer Court ',❑ Motel ❑ Other -------------------------------------- --- Number of living units:-a•_-------- Number of bedrooms ------3----Garbage Grinder ------------ Lot Size 130-?---X__74r-------------- ______- Water Supply: Public System and name ----------------------------------- ------ ---------Private ❑ } Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loamy Hardpan ❑ Adobe DX Fill Material ------------ If yes, type ---------------------------- A f (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,) ' eI' PACKAGE TREATMENT [ ] SEPTIC TANK"y] Size-------,-P.X8t---------------------------- Liquid Depth ----54-a_---------_--- t _�. l 4 - . --........Y-- pQ # Capacity 1200--Gals Type r -�ca -_ Material`JConarP-te-_ No. Compartments -----�':.............. ID Distance to nearest: Well --------None--------------------Foundation -------W,--------- Prop. Line __- ------- GQ LEACHING LINE [ No. of Lines ---------2-------'----- Length of each line- __----05r------------- Total Length ------- ------- � 'D' Box :_71- _:~ Type_Filter Material'._SPPW__R1.6epth Filter Material -----10-1--------------------- � ----- F 'r`-_ Foundationl&t--------------------- Proper- "Cine - Distance to nearest: Well None---------- _ - _ tYi -----�?-------�...._. f� V SEEPAGE P17 Depth ----25-t---------- Diameter`"___ Number______25t.=--- "'-- Rock Filled Yes [KX * No I❑ .� i1------ Water Table Depth -----8 =---------------- --------------------Rock Size -----Ii F-x3,t-n--------- °- < Distance to nearest: Well ---------14one-------------------------F unclation _ ? _- '_______ Prop. Line ..___ ?_..__._ ._. 1 REPAIR/ADDITION(Prev. Sanitation Permit# -------------------- ----,-- ------1-"Date -------------------------t--------} i Septic Tank (Specify Requirements) ------------------ { t ---- ----------------------------------------•--- ----•---------------------'-------: Disposal Field,(Specify Requirements) ------------------------------------------------------ t ------------------------------------------------------------------------_-------------------------- - j (Draw existing and required addition on reverse side) # I hereby certify that I have prepared-thi's_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: t "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's ensation la of allfornia." Signed D. A. PARRISH- & ONS �--- --------- - ----- By --------------------- -------------------------- ------- Title ----- st�ma�or (If other than owner) --- FOR DE RT NT USE ONLY APPLICATION ACCEPTED BY,&, . - _ ---- -------------------------------- DATE __ --��-: �------- --. BUILDINGPERMIT ISSUED ------------------- ------------------------- ---------------------------------------DATE ------------------------------------------. ADDITIONALCOMMENTS ----------------- _------------------------------------------------------------------------- ---------------------------------------------------------- ------------- ------------------- ---------------------------------------- ----------------------------------------- ------------------------=--------------------------------------------------- --------------------------------------------------------------------- ------ ----------------------------- - ------------------- P ------------------------------------------- -------------------I------------------------- ----------------------------------- -------- ------------------------------- --------------------------------- ---- ------- Final Inspection by. ------- lJ Date . = SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M ;{�'✓ -