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' JOR OFFICE USE: APPLICATION FOR7SANITATION PERMIT <br /> = <br /> /t?-.36 Permit No. _7.. " ... <br /> -------- . _..... ............... <br /> (Complete in Triplicate) <br /> .......... ............ ................__- _ Date Issued <br /> i This Permit Expires 1 Yeas from Date Issued <br /> Application is'He're-by made to the San l H <br /> Joaquin Locaealth District for a permit to construct and install the work hereir. <br /> described. This application is made in compliance with County Ordinance No, 549 and existing Rules and Regulations: <br /> ' 2482 Car enter Ad ..._.-_..... CENSUS TRACT - _..___---_-----_-_--. <br /> JOB ADDRESS AOCATION . r --•------ -P------ ' <br /> Owner's Name .Ted- 1nl.ill.iaIIJS-._. . --- --Phone 462-42-39.. ......_._. <br /> Address � same-.. ..-- ---- ....:..... ............ ............. <br /> ....... Cit Stockton------ -- - ---- - -........................ <br /> Contractor's NameBlaekard'S'.Septic Tank - --_ --.- _License # 268.951-------- Phone 463-70.48......... <br /> ---- ------ <br /> w ll_serve:k Residence:]Apartment House❑ Commercial ❑Trailer Court ❑ <br /> -- '..Motel F-1 Other _. ----- --- - --••------- - <br /> Number of living units:....:1_._-._ Number of bedrooms -..-4. -__Garbage Grinder ..r..��-.. Lot Size ...2--Acrel----.---- •-- • ----- <br /> Water Supply: Public System; and name -.-.--_. Private <br /> - a <br /> Character of soil to a depth of 3 feet: Sand❑ Silt 0 Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> �1 Hardpan E] Adobe ] Fill Material .... ----- If yes,type ....... ------------- <br /> (Plot•pldn, 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`seepdge pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ 1 SEPTIC TANK.frj . ; Size - 5.4"X6 s X 10 ------.. L'+quid Depth . ..__... -�............. <br /> Capacity 1600 Type -Sg, .!._....- <br /> Material.CaYLCre.tB No. Compartments .......-Z___:........ <br /> % <br /> i Distance to nearest:, Wel150.!- .. - ----- __•w`-••Foundation ....-20 201 _7 Prop. Line .-7Q_.............. <br /> LEACHING LINE $J No. of Lines ...2.--- =(-'Length of each il-iec•....85f_. .- -- ...... Total Length __-17D�............... <br /> �. .. . <br /> F . 4 <br /> 'D' Box ..1_-. Type Filter'Material .....2':..........Depth Filter Material ZC)„------------•----- ----••- <br /> Distance to nearest: Well -_-_�_ -- - Q.'...-._._Foundation_ ,15�---\--Property Line .......4 Q�._.-.-•--- <br /> -- 1 <br /> •..-__-.. Diameter 3 Number .___---. -...-.__.__ - Rock Filled Yes ® No C] <br /> SEEPAGE PIT [$ Depth ----25 - - -- <br /> I Nater Table Depth - ..... ---4Q-0--- ---- ------ ---•-- --.Rock Size -.-2."-. -------------------- <br /> 11 <br /> --------------- -__ <br /> Distance to nearest: Well --..100-'---- .--- -- <br /> -_-Foundation 3 00 Prop. Line'.._--.4'-Q�..------•- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ------ ----- ---- Date -___ ....•.----_-- } <br /> l1600..-gaJ . ...----: ---- ---••• .....------------------ -------- ------------------..-_.. .. <br /> Septic Tank (Specify Requirements) .-.. �. y � t ,-J .,� <br /> ( Disposal Field (Specify Requirements) -------------1.7W---Leach. U-n-e & '2 � t9 j 25th 36't.--------------"---'--' <br /> -- ---- <br /> Disposal <br /> ..--_... --------------•-----. .._...__.........•- ---•-• .............. <br /> ' ..... --- - -- - ------ ----.._.......---..__...._ j• ' ................................... <br /> .--_._.. .-..••---•-... ......._............................... ............:......:. <br /> .... ._..- _ _ _ <br /> (Draw existing and required addition on reverse side) -- . <br /> I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents 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 <br /> as to bec a subject to Work an's Compensation laws of California." <br /> Signed . Owner <br /> By .. - - £ill---Bla-ekard. ......... ... <br /> _ Title _-CDritractnr-- ----------- .. <br /> V. <br /> (If other than owner) <br /> i fOR EPA NT SE ONLY <br /> APPLICATION ACCEPTED BY, __..-f !t'` - DATE 7 - <br /> •>DATE <br /> BUILbING PERMIT ISSUED . ......___. i 'x> <br /> , <br /> ADDITIONALCOMMENTS....----- ............................................................... ...-•... ............:.. <br /> .1.-.--7 - -- ............................................ <br /> - .... -. n <br /> t . - : ..... .. .. .......... ...i1 L � �L,Y, _ _ ........... �- l a..•..-......... <br /> .... .-- - .-Date .. ...... . ..... ..... .. <br /> Final Inspection by�-.--- . - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />