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FOR OFFICE USE: y lr t1 APPLICATION FOR SANITATION PERMIT ' - J Permit No: 71?n__q 6•_3 (Complete in Triplicate) ____._______________ ------ ------------------------------ This Permit Expires ] Year From Date Issued Date Issued ._T--_/_7__7 Z 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: JOB ADDRESS/LOCATION ------11326 E. Hiway 2 _ - _=w �, -----..CENSUS TRACT- .-------------------------- Owner - . _...� _ . — - ... . . Owner's Name __FT'a'nk---Cedi.7le--------------------------------------------------------------------------------------------Phone _9_31g?21CL-5--------------- Address ---------S.am_?------------ ------------ - ---. City --------------Stockton - Contractor's Name B1aCkard-t-5------------------- ------- ------.License # . 268.95 Phone _ ( -r�0��. ------------------- Installation will serve. Residence [3Apartment House,❑ Commercial ❑Trailer Court '❑ Motel ❑Other ------------------------------------------- Number ------------------------- ---- ----- --Number of living units:_______.. Number of bedrooms ___2_-._.Garbage Grinder "_..__ LotSiie . :=AQI` S------------------------- Water Supply: Public System and name ------------------------------------'------------------ -------------------------------------------------------Private] Character of soil to a depth of 3 feet: Sand'[:] Silt[] Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe'n—Fi11 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.) N, NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,] PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size-------------...-------------------------------- Liquid Depth ------------ ....... Capacity -------------------- Type --------- --------- Material---------------------- No. Compartments -•--•-'----- Distance to nearest: Well ---------------------------------Foundation ------------ Prop. Line ---------_---------- LEACHING .--_................LEACHING LINE [ No. of Lines -_______1............... Length of each line.------- Total Leri th ,_. ► 'D' Box ---z______- Type Filter Material -------- .+_._.__.Depth Filter' Material ---3,9"---------- ...................... V Distance to nearest: Well ------50-# Foundation ______SQA---------- Property Line ._J.Go_Q:_.._.-.--- SEEPAGE PIT ] Depth ..2s t y____-____ Diameter __-_3 --- --- Number ___--__------- Rock Filled Yes E] No . rs Water Table Depth -------R10.1--------------------------------Rock Size ------zn--------------------- Distance to nearest: Well --100-0.............................Foundation __1_G0 _! Prop. Line ........J.Q0 a__.. REPAIR./ADDITION(Prev. Sanitation Permit# ------- ----------------------------------- Date -------------_.-.----.-----------_) Septic Tank (Specify Requirements) -------------- -------------------------------------------` Disposal Field (Specify Requirements) ----------- �' 3t'X�3r�-----P-lt--------------------------------------------- --------- ----------------------------------------- --------I------------------------------------------------------------ --------------------------------- ------------------*--------------------- ------------------------------------------------ ----- -------------------------------------------------I-------------- -------------------------------- ---------------------------------------- (Draw ------------------------------------------ (Draw existing and required addition on.reverse side) �A I hereby certify that I have prepared this application and that the work'will.-be done in accordance with San Joaquin County Ordinances, State La ws; and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the followin'g:T _ "I certify that in the performance of the workwfor which this permit is issued, I shall not employ'any person in such manner as to become subject to Workman's Compensation laws of California." Signed ------------------------------------------------------------------------------------------------- Owner BY --� 'e ---------------------- Title ---- ' _ a (If other than owner) `'x�F&DEPARTMENT USE ONLY � APPLICATION ACCEPTED BY - --------------------------- � s=i-------------- --. DATE --------��{ �--------- BUILDING PERMIT ISSUED . ------- ------- ----DATE '------------- ---------------------------- ADDITIONAL COMMS TS - ---- ----------- = ' - ---------------------------------------------------------------------------------- ----- -- � s Al`� --- --- --- -: -- - - -- -------------------------------------------------- -------------------------------------------------------- =^ ------------ ----------------------=------- Final Inspection by: f --------------------------------------------------------------------------.Date ---- --7-ML------------- �' JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M