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E ' FOR OFFICE USE- i APPLICATION FOR SANITATION PERMIT Permit No: .73 {•.••- : (Complete In Triplicate) k................................................. ...•---- p 07 �.3 Date Issued j. .................. .._....',,, This Permit Expires 1 Year From Date Issued Application is hereby made'to the San Joaquin Local Health District for a per 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 .....CENSUS TRACT .......................... i� ......._...........Phone ....R-31-L? .42-6............. Owner's Name ----.F.red..Pa at..................................... ......................••••---•--....:., Address Sa• ae Stockton City ....... I Contractor's Name /B ackard' s Septa.c••.Tank z6Q95� .... Phone �6�••-70�8 ...._... License # ......... i Installation will serve: Residence:0Apartment House❑ Commercial ❑Trailer Court 0 Motel ❑Other --------------- ....................... 9 ........ . 9 Lot Size ............................ Number of living units........._._ _ Number of bedrooms _.........._Garbs a Grinder ... Water Supply: Public System and name ---------- -------------- --."-•-------......•----•-•---. ....._.....--------••--••-•-----........ ••-private Character of soil to a depth0'of 3 feet: Sand 0 -.Slit❑ Clay ❑ Peat[] Sandy Loam j Cloy loamrQ Hardpan ❑ Adobe ❑ Fill Material ............ If yes,type ................... ...r - t (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,j' PACKAGE TREATMENT [ ] SEPTIC TANK l' ] Size------__•-•....................••••......---.... Liquid Depth ...................... Type ..... Material...................... No. Compartments ._......-•._... Capacity...',-:. - ....................4.. 00 �. _... Distance nearest: Well ....................................Foundation -•------.. ........... Prop. Line ..---.........._...... V • Total Length .....'.. t............ LEACHING LINE Ed No. of Lines -----------. Length of each line..........1. ()A.._.....__ g !�{} i " 9 ............... 'D' Box ...�______ Type Filter Material ...Depth Filter Material .........�.�_...:. Y Distance to nearest: Well ........1Q0.'...... Foundation ...._LQ.'.........--. property Line .....?Q............. . o SEEPAGE PIT WDepth .._..__...2 ..... Diameter - -... 3�}_. Number ----• ........ -.. Rock•-Fii€ed—Ye M No Water Table Depth ._ .................... Rock Size }:.: +[ Distance to nearest: Well ............... D0:'.........I......Foundation .......3Q.!.--.._- Pro Line ......2. 1......... REPAIR/AIaOTYM(Prev. Sa nitation Permit# •-•.................................:........ Date .......:........................... j � SepticTank (Specify Requirements) ------------------- ..........-...............................................:........................................................... Disposal Field (Specify Requirements] .... .............................. .......... ------------------------------•-•-------.....----.........--------•--------------•. ........................---------•--•---••-------- (Draw existing and required addition on reverse side) ^c$ 1 hereby certify that I have prepared this application and that the work will be done in accords :.th San Joaquin County Ordinances, State Laws,'and Rules and Regulations of the San Joaquin Local Health District, Home owner or [icon- 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 subject to-Workman's Compensation laws of California." ' Signed " ..... Owner ' By .. G �........ ... . ............ Tlrle ...........Contractor.......:_.. (If other than owner) Ir FOR DEPARTMENT'tISE ONLY APPLICATION ACCEPTED BYi _............. DATE ..... Z . BUILDING PERMIT ISSUED ..DATE ................ -------- ADDITIONALCOMM ' ... ... .... ....................•--....................--•-- ......._.:.•-------...............------------.._........:.---------...............`: .. ... . . ......................••. •----- :. . ......----- -•---•---..__....---------••---...------..._..--- � �...... ._-••� FinalInspection by: __... . ................................................... ........Date ....d �,�/y ..:.............. '�/ �l JOAQUIN �LOCAL HEALTH DISTRICT F 14 13 24y.'d� ize�_ Mi 7/723,M