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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: ---------------- - - ,%(Complete in Triplicate) Permit No...7_f- -�d---- •-------- ------'--- -'------' ----------- ---- --'- �� --------- ----------------------------------- This Permit Expires I Year From Date Issued Date Issued__S'31_-_2 f Application is hereby made to the San Joaquin LocI IIHealth 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•_.' .�- . - --------CENSUS TRACT Owner's Name- -------- ame - =----------------------- - ---------- , - ----Phone--------- Address-' , lilel--- ----- * � i �. -------------------------City- Z i P ------ r! Contractor's Name:_-- st License 7-�c?.�� - ----- ' -------- �_j�_f_7___--Phone Installation.will- serve: Resideneex Apartment House ❑ Commercial ❑ Trailer Court ❑ t Motel ❑ Other-------- == c Number of living units:.___- _. Numberlof bedjoms_ _�_ _Garbs e Gri �' �,5�9 '_Lot Size___Water Supply: Public System and name_ ¢� Lam' -- P y _. ". ---------- -- Private ❑ Character of soil to p depth of 3 feet: . Sand ❑ Silt❑ 'Clay ❑ Peat❑ Sandy Loam ❑ i Clay Loam ❑ Hard on : ' p' ❑ . Adobe' 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 p'it permitted -f ublic sewer is available within 200 feet,} PACKAGE TREATMENT - T [ ] :SEPTIC TANK [ ] crSze------------- t = Liquid depth. ------------- -=- Capacity_- ----r ----,-TYPe-- ----- -.-_Material----------- ------ No. Compartments----------------------- R Distance to nearest: Well =-=---- - = _Foundat.ion Prop. Line - 3-._ �. LEACHING LINE No. of Lines.___._ ._ f__ __-rLength f eac line.._-_-��_-�_____.-_Total Length ------ =- I g x D' Box._-_r__- _Type Filter Material= Depth Filter Material___-!_T_- f_ ` 4 - -- ( Distance to nearest: Well--, - ,C+ Foundation__ f -----------Proper Line--- ----------------------- SEEPAGEY PITDeptht�„�'r.. f ... fi f P ''�5 - - _--__-.-__---__--Diameter__ ViNumber -------------------- Rock Filled Yes / No+ ► ' ] 19i ❑ f Water Table.-'Depth _ - ------- --------------Rock Size-- --'�- r --------P---------- Distance,to nearest: Well--�� .. '� 'i �' = �'�l ----------.Foundation--'-- Prop,op, Line-- --- ----------------- REPAIR/ADDITION (Prey. Sanitation Permit#__:- ___:_____- +. --- Date ------ -------- = --- ------"-- --------- Septic Tank (Specify Requirements)-__.__. : '--:--- - - Disposal Field (Specify Requirements):._ rl ------------------- �� �. J - --------------------------------------------------------------- -" .--- - - - ---- _. (Draw existing and required addition ori reverse side] .. a s ; I hereby certify that'l have prepared this application and thai the work will be'done rdin accordance with San Joaquin,,County inances, State Laws, and Rules and Regulations of the Sari Joaquin Local Health District. Home owner or licensed agents signature certifies the following: "f certify that'in the performance'-of the work for which this permit is issued, :l shall not employ.an to become subject to Workman's Compensation laws of Cplifornip."' . Y person in such manner as Signed------------- ---- ---- E } ` SSE TIC l� SEWER SERVICE �CLARENCE' P E '----------------------------- > - - .::_--.---- --------------Owner '763 So. gro 4 Stockton, Calif. 95205 . , BY------------ -- ---- PhA63-32D9 Caritractor'siJc.#267171# ------ Title.----- (If other`th na owned " `,, .. ' " _ - " - " FOR DEPARTMENT SE O Y` APPLICATION ACCEPTED-BY -_-- ; - ---------------- DIVISION OF LAND NUMBER ------------- t___-_-- ADDITIONAL COMMENTS- ---- ---------- �.J1f �_�� f{ DATE... ' ..; _ : ------------- --- 6 fry - --- I --- ------------------------------------ - . `— T _---___________ Final InspectionbY° ----------------------------------- ________________ ________________________________________�n___. " _= r .G = ------------ —` ":Date- /--`� = `- ---- EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&s 21677 REV, 7176 3M