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APPLICATION FOR SANITATION PERMIT - ................................. _.. ......... . . ��-/5 .. ` (Complete in Triplicate) Permit No.........- ..........:.............-......... ............ Date Issued...3.". ......... ...........I................ .. _... This Permit Expires 1 Year From Date Issued ripplication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. chis application is made in compliance with County Ordinance No. �549, and existing Rules and Regulations: JOB ADDRESS/LOC ION.....�gJ.. . .... ... 5. vaVl . .1. 1/L. r .�.....EfR�QV1--CENSUS TRACT.----....... Dwner's Name ... ... ... ..Phone g Z ....... .... Address.......... 0�_........:..�./� . t',.'.`v..1�1_. 1 �. City f JC71 1..._ . .. . A, License #-.? - 3. Phone... 40.(40 � --- Contractor's Name.. .f,..�Gi!.Ir►�lsln-.�So-Y,.S .. 5� Installation will serve: Residence ) Apartment House ❑ Commercial ❑ Trailer Court Q� Motel ❑ Other _. _. .................... Number of living units: _ ....... Number of bedrooms ..... Garbage Grinder........ ...Lot Size........ 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 ❑ okelQbv-K 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,) PACKAGE TREATMENT [ J SEPTIC TANK �(J Size 1. - -- Liquid Depth.-... ..-. W \ .. . -- Capacity. I-Ycro..Type ._.No. Compartments .......................-..._....,� 51 Distance to nearest: Well... . 100 -Foundation....t Prop. Line...lQ.. - 5 LEACHING LINE {(] No. of Lines - . ��...... Length of each line ... -i, . . Total Length . .-- - �• 1 'D' Box _ . Type Filter Material. _. . I... Depth Filter Material.. ...... . ...... ..... .... Distances to nearest: Well.............. . . ..... Foundation...................... .. ..Property Line.............. .................... .� SEEPAGE PIT [?� Depth_ Diameter.-&IX-ko.. Number ...,i------------------- Rock Filled YesX_ No❑ M 1 36 y Zo Water Table Depth.................... ... .. ........................Rock Size.....3/l.� X.�.��-------------- Distance to nearest: Well_...1-0.0f- ._ _.. _ ......Foundation_. Prop. Line...l.04.. ....... REPAIR/ADDITION (Prev. Sanitation Permit#....... -------. ... ._......Date.. .......... _.. ... - ..._.._..) Septic Tank (Specify Requirements). _. _........................�. -. _........ .... ....... .......... Disposal Field (Specify Requirements) -!�^ / " p '^"` ... -...- ----- - - /S l•�--� (Draw existing and required addition on reverse side) I hereby certify that I 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 licensed 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 or�[mgn's Compensation laws of California." f1. 1'�f 1�nH gt 5, . r Si ed.... Owner POST OFFICE F1O;, 1,'f.0 By...... .... -. STOCKTON, CALEFOF;t!?-4 43201 Title (If other than owner) FOR DEPARTMENT USE ONLY -- - -_T APPLICATION ACCEPTED BY // =^'t �J� DATE DIVISION OF LAND NUMBER ` DATE ADDITIONAL COMMENTS FinoI Inspection by: L' r�i � �- �� Date EH 13 24 SAN JOAQUIN LOCAL HEALTH DISI-RICT res 2167 7176 3M