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APPLICATION FOR SANITATION PERMIT <br />......................... . . . ........ Permit No......... S <br /> (Complete in Triplicate) <br /> Date Issued.. <br />......•--- - This Perm.it Expires I Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION I �'L� _ �.n..vati . Allen.. - <br /> ........... .... . CENSUS TRACT.................. ....._ <br /> Owner's Name ,. �Y.. Phone --- <br /> Address <br /> - -.- <br /> Address.......rj. �Y-\Ooxo. . `�� - Cit /.<QIvV�.... ........ _.Zipi y...l� . . P- ... ... .Contractor's Name��A rrf S .1A ... _. 'S. License #. �JjPhone. .' �G .`Z.... <br /> Installation will serve: Residence jA Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> Motel ❑ Other .. . . ................. <br /> Number of living units: _ Number of bedrooms 3 Garbage Grinder ._ ..Lot Size__.- _ . .... ... <br /> ......_ <br /> Water Supply: Public System and name __ ................Private ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ bay ❑ Peat ❑ Sandy Loam k Clay Loam ❑ <br /> Hardpan ❑ Fill Material If yes, type..... . ........... <br />(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK � Size � .... . ._ Liquid Depth .. .. . .....w <br /> Capacity 1(p0C Typef�CO-Z2�Material ..GG--.<.�C�. _ No. Compartments . ..Zi....... ..._ _.� <br /> Distance to nearest: Well .. .(.�?� 'f' - Foun ation_.. (O fi . Prop. Line..... n..A- -- ---- � <br /> / 1 <br /> LEACHING LINE [✓J No. of Lines _ Length of each line ... Total Length �....- <br /> 'D' Box Type Filter Material .. Depth Filter Material .... __...... . ... ............ .._.. .-. ......... <br /> Distance to nearest: Well...l.(>C,-) -A— Foundation. .....�C�..-tl'.. .Property Line_A0..+—........ ......... <br /> t � <br /> SEEPAGE PIT Depth a�Diameter. r-k�-Number —3. ------ .. -- <br /> Rock Filled Yes ❑ No ❑ <br /> Y <br /> �/xa / Water Table Depth...... . .�� _... __ ____ .. ...........Rock Size. ..3/r-{. x ..�..�. . ......... - I -. <br /> 36 0 - .. <br /> Distance to nearest: Well. ..[ 00. ......Foundation . (0 Prop. Line... ....... <br /> IREPAIR/ADDITION (Prev. Sanitation Permit #.... . .. .-. _ .......Date.._._..... ) <br /> Septic Tank (Specify Requirements) .. .. . .......... <br /> Disposal Field (Specify Requirements) __. . _ .................... _. _ ... ... <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health District, Home owner or licensed agents <br /> signature certifies the following: <br />"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 <br /> to become subject to Wd kWar� ,,Rj er},Sati ;,§a l�l.f California." <br /> Si ned. uu AA P ST,'Oi FI-FC FCCi(`," . `.50 l' Owner <br /> By.... .- STOCKTON, CALGJi ;,1;1 95201 Title <br /> (If other than owner) <br /> FOR DEP RTMENT USE ONLY <br /> APPLICATION ACCEPTED BY l/�. �^ DATE v �— <br /> DIVISION OF LAND NUMBER DATE <br /> ADDITIONAL COMMENTS <br /> Final Inspection by: C v'-�� �. . `� L�7 Date y" �7� <br /> EH 13 24 SAI I JOA00IN LOCAL HEALTH DISIRICT fas 2io» uEv (�y3m <br />