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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. -- -- -- ---------------- - ----------------- (Complete in Triplicate) ---------------------------------- ------- ------------ Date Issued -- --- - -- ---• This Permit Expires 1 Year From pate Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein t described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: � ' 4 JOB ADDRESS/LOCATION ------?535_--- ,--Ha l----------Sto_ckton, _C_a.--------------------- -- -CENSUS TRACT • ---- ; Owner's Name ---------JQ$n- Wi3.ati1S------------------------- --------------------- --- Phone62 7357----- 1z --.N.---Wilsan__W City =-------------- Address ---------------------=---------- = ----- Phone ------------------ k Contractor's Name --------PaTJ,.Dh-----IS1C ft----------- ----------- -------------- --License # -- -----.------- -- --------•-- 1 Installation will serve: Residence 2Apartment'House❑ Commercial ❑Trailer Court l❑ ; Motel ❑Other ----- -------------------------------------- - Number of living unit ) _------ Number of bedrooms --{ }..Garbage Grinder -.y-es-_ Lot Size - -t-X18jt Water Supply: Public System and name --------------------------- - --------------------------- ---------Private X Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ElPeat ElSandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe-[S: 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 SEPTIC TANK Size------12 -4 f X---51-------- Liquid Depth ----52................ PACKAGE TREATMENT [ ] D W Capacity 1800-------- Type Precast_ Material____COnc__r--eteNo. Compartments --_---...�-Z�.---=- ' Distance'to nearest: Well -60 ---------------------------Foundation ---------I-)--------- Prop. Line .35-1- ...... f -- -----...------ P �Z� Length of each Zine Total Length -- l � ----_------- LEACHING LINE [)qx No. of Lines 'D' Box {.COIF-. Type Filter Material ----1��--__---_Depth Filter Material ___l*----— 2 ______----•-,-._- Distanceto nearest: Well -----6Q1 ------ ------ Foundation ---10R__ft_,---- Property Line --------52........... SEEPAGE PIT [ ] Depth5_'.----------- Diameter 36r�-------- Number ..-(_�-)-------------* -- Rock Filled Yes No C1 0 t --Rock Size -1 1# X 2 Water Table Depth ----.-5------------------ -------- t --- 5' Distance1to nearest: Well -.-105-----------------------------FoundationProp. Line --_-.- (Prev. Sanitation Permit# ----------------------- Date ---------------------------------- REPAIR/ADDITION ) Septic Tank (Specify Requirements) ---- ------------------------ --------------.-.------ ---------------------- Disposal Field (Specify Requirements) ------------ -------------------------------------------------- ------------------------------------------------- ------I------------------------ ----------------------------------------------- ----------------------------------------------------- 1 (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 liven- 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 Compensation laws of California." Signed -----------------Parrish---InC-a------------ - ------r Owner Pres.------------ By ------------------------�� r`A1 t'C Title ----- -------- ---------------- (If other than owner] l FOR -DEPARTMENT USE ONLY t APPLICATION ACCEPTED BY -___-- - ------------------- DATE ---- --Z -- - - ----------------------------------------- BUILDING PERMIT ISSUED ------ DATE ---------------------------------------- ADDITIONAL COMMENTS -- ;0-44-- -Q ------- -'�� 1��7z -------------------------------------------------------------------- - ------------------------------------------------------------------------- ------------------------ - -- --------------------------------------------------------------------------- -- --- ------------- - - Final Inspection b Date --- --2� SAN JO UIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M