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FOR OFFICE USE: APPLFCATION FOR SANITATION PERMIT Permit No. 7 .�/ _•-.F: '16 iComplete in Triplicate) i ..._...._....._....... r � ... . �V... ............ .. 3 Dote'lssued / . - ..... This PerExpires ] Year Prom Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work 'hoein described. This application is made in compliance with County Ordinance No. 549 and existing ,Rules and Regulations: t. J v r + JOB ADDRESS/LOCATION 'CENSUS TRACT ......Sao------�•.•-,Ga1dgn..G.at.B•--._..._.......................................:. ........................... Owner's Name Mrs--Del Rio_ ;� Phone -•-•• -- 7+- -- ....................-------- r Rot"o "Rbo Golden Gate Stockton l Address ._. ............ -------------- City ..........._.._.... _.. ........._... ter"" er � 271 39 _z l ......: License # . Phone ............. � Contractor's Name ..................... ....--•--•-•-=•-_ M Installation will.serve: i Residences❑Apartment House f) Commercial❑Trailer Court C] 'A Motel ❑Other--------- --------------------------------- 60 x 100 Number of living units:-...�_..___ Number of bedrooms 3 Garbage Grinder nOLotSlze ---- ........................ r . Water Supply: Public System and name ...................CMaLi1:_'__WatJar................ ................................:.........Private ❑. Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat OL Sandy Loam f j lay Loam ❑ • q ' r, Hardpan p Adobe r] Fill Materlal ............ 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'ifpublic sewer is available within 200 feet,) PACKAGE TREATMENT .) I SEPTIC TANK ,I Size.-•_......... ...................... .............. Liquid Depth ----...................E.. r , Capacity --- - Type Material---------------------- No. Compartments ----._..__-- ...... y Distance to` nearest: Well ---Foundation Prop. tine ....... ............... LEACHING LINE [ ] No. of Lines ::--:..". . Length of each line.................... Total length 'D' Box - -,Type Filter Material .......Depth .Filter Material ........................................... N Distance to nearest: Well _._.."..._-__-_--._--- Foundation _.................__ Property Line ......................... SEEPAGE PIT, [ ..� Depth .-----'---"�`-:-"'� Diameter ---------------- Number ---•------._.-.._..._...."-- Rock Fitted Yes ❑ No d ww�wrwYr� 1 , Water Table Depth .Rock Size Distance to nearest. Well ...................•- .Foundation ........... . Prop. Line ....:................: r r REPAIR/ADDITION(Prev. Sanitation Permit# _._:................•---.-_-_---- - -- Date .................................. Septic Tank (Specify Requirements) -----....... a ._10_ ... ndl.- Hx € ................ - 3 - Disposal Field (Specify Requirements) --------•--- b 6I...by •8-� 5 ?............................ 9 • ..._ .."._.___-...___________________________"....._....._.___...._...__._.___.___..-__--._.-.-_..-..•--.---_-._.__•____.________-__.._...__.................. (Draw existing and required addition on reverse side) j I hereby certify that l have prepared this application and that the work will be done in jaccordance 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, l shall not employ any person in such manner- as to become subject t orkman's or�p ration laws of California." l�4/ �a Signe Owner k ----------------------- ------------•---- By ...... -----• .......... ........ �e---Whits-------------------------------------------- Title _------Gont-actor--•- --••---•-------.... ................ (if of er th n owner) . R DfPARTM T USI: ONLY S ' APPLICATION ACCEPTED BY ------------- DATE BUILDING PERMIT ISSUED --- - -------------DATE .-.. . -• --....----......----•- ---...a-. ADDITIONALCOMMENTS ...................----------------I....._._...... .._.......-•-•--... .... : .............--• ..- 5 r ________________________________________________ " ..M_' i ______________________________________ ........- . _ ------- ._ _ _ __..._ ..- ..____i.._---..__..................................:--------------....�C1 "1. � - Final Inspection by: -• ----•-•---•................... Date ... .--- ... ............................. EH 13 .24 1.68 tdev• SAN JOAQUIN• LOCAL HEALTH DISTRICT `8/7h 3M