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P�o �- f o P AR u5 E- ------------------------------------ FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -------------------- - - ---------------- ------------- Permit No. °r (Complete in Triplicate) r Date Issued _-�....... . ..... ------_--__________________________________________ __ This Permit Expires 1 Year From Date Issued ms ;Cinstall�� I., /�0 7 Application is hereby made to the San Joaquin Local Health District for a permit to construct the work herei6— described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: 1850 W. Sonora JOBADDRESS/LOCATION --------------------------- ------------------------------------------------------------- - ------ ------CENSUS TRACT -------------------------- Owner's Name Val Sar>--A sDci-a t- ------=----------------------------------------------------------------------Phone 46.3-9.79-7--------------- P.O. B©x 958 Stockton , Cal Address ------------------------------- -----------------=------------------------------------ ------------ City -------- - - - - - - -- ---- - ----------------------------------•--- Contractor's Name ---------ow.n_er ------License # --- -------------------- Phone ----------------_------------ Installation will serve: Residence [N Apartment House-E] Commercial ❑Trailer Court ',❑ Motel ❑ Other -------------------------------------------- Number of living units:-----*-*------ Number of bedrooms _----2---..Garbage Grinder ------------ Lot Size -.---_-1501--_x_-100.1---------- Water Supply: Public System and name ------Calif om i3_4:atex---Se_r icE___________________________________________Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ 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 pit permitted if public sewer is available within 200 feet,] i PACKAGE TREATMENT { ] SEPTIC TANK Size----------_-- _- �_x-_--_r .---_-_ Liquid Depth ------___--------------- qQ Capacity T o-�cv-t de 0_ aterial- --- --- ---- - - o. Compartments _Z--_- p Y Y f Distance to nearest: WeII�NoN-------------------------Foundation ----z4----------- Prop. Line __J40__---___-_--_ LEACHING LINE [ ] No. of Lines ---------------_-------- Length of each line---.------------------------ Total Length _______.______.______.._.-- 'D' Box ------------ Type Filter Material --------------------Depth Filter Material --------------------.--_--------------.___.. Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line ---_--_._-_-_-_-.--_-- 1 SEEPAGE PIT [ ] Depth -----z- ------- Diameter ----_�--------- ! Number -------/-------------------j.. Rock Filled Yes No 0Water Table Depth ------------------------------------------------Rock Size /-Y----------------------- i ---zRDistance to nearest: Well ----------------------------------------Foundation ----t'F�--------- Prop. Line ----- REPAIR./ADDITION EPAIR./ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ____-_-----_--.----_---.-_.__-----] SepticTank (Specify Requirements) ---------------------------------------------------------------------------------- ---------------------------!----------------------------- DisposalField (Specify Requirements) ------------------------------------------------------------------------ ------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------- ------------_--------- -------- ---- -- --- - - - -- - ---- ----- (Draw existing and required addition on reverse side] I hereby certify that 1 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, I shall not employ any person in such manner as to become subject to Workman's Comp sati.on s of California." Signed -6-L --------1 G-`-=�-�'"�{�-------------- --- -- --- --- -------------------- Ownerf BY ------------------------------------------------------------------------------------- ----------------- Title ------ ----------------------------------- --------------------------- (If other than owner) 00 FO DEPARTMEN USI" ONLY APPLICATION ACCEPTED BY DATE 1a _ O -_ 1-. BUILDING PERMIT ISSUED --- --- ------ ----- -D TE ----- A ITIONAL COMME TS - ---- ----- ------ --:---- ------------------------- d ,t~,1� Q, ------- ---- --------------- -------------------- - --------- - ---------------------- ---- ----0 hD - ---------------Q� ---------------------------------------- --------------------J FinalIns ction b ------------------------------------ ----------------------- -------Date .../Z'! l- /_'71------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M