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FOR OFFICE USE`"` APPLICATION FOR SANITATION PERMIT / <br /> �................. .......-.. ........ Permit No. <br /> (Complete in Triplicatel <br /> •----- ------------------------ ..... <br /> This Permit Expires I Year From Date Issued Date issued��.'-- -_"•-• <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application Is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> .JOB ADDRESS/LOCATION ..12081-.No.......Ja­k­..To..ne,,.Rd. Stockton <br /> . .. ..... I.....................CENSUS TRACT ....,.... ..... . ....... <br /> . <br /> • --- <br /> Owner's Name Pe.te_-Ja.UrCe9g1tQ.........................................................................................P one .-... ... ...931249.1.................... <br /> AddressSame.. ... .......... ......... ........ - ........._.........................City ...,..... ....... ...... ................................-.........--------- <br /> 0 S Tank Ser. License #3077-21 Phone 3683933 <br /> Contractor's Name .-G..-$c.-....--.:its? . ..-_. ............................ <br /> Installation will.serve: Residence J0 Apartment House] Commercial[]Trailer Court 0 <br /> Motel []Other ............................................ <br /> Number of living units------------- Number of bedrooms ............Garbage Grinder ............ Lot Size ............................. •---••••` <br /> Water Supply: Public System and name ----------------................................--..................................._. —...................Private ❑ <br /> Character of soil to a depth of 3 feet: Sand 0 Silt Clay 0, Peat[I Sandy Loam❑ Clay Loam 0 <br /> Hardpan Q Adobe[)"F.ill Material ............ If yes,type ............... ............ <br /> �i <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 Lis available within 200 feet,) <br /> PACKAGE TREATMENT [ SEPTIC TANK{ ] Size................................... .......... Liquid Depth .......................... , <br /> Capacity -------------------- Type --.................. Material.........- ----- No. Compartments .............. <br /> Distance to nearest: Well ---------------xk ..................Foundation -------..._.._........ Prop. Line ...................... <br /> LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------................... Total Length ............................ <br /> 'D' Box ----......-- Type f=ilter Material ....................Depth Filter Material ........-----•............-...._.. ......... <br /> Distance to nearest: Well ------------ Foundation ........................ Property Line ................... <br /> SEEPAGE PIT { ] Depth -------------------• Diameter ................ Number ............................ Rock Filled Yes ❑ No <br /> Water Table Depth.............................---.................Rock Size .-..----_----------------_- <br /> Distance to nearest: Well ........................................Foundation -----............... Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date --'-. ....................I <br /> SepticTank (Specify Requirements) .........................-------------------:--------...------•------....------....__.....--•---------------.-.......-........................ <br /> Disposal Field (Specify Requirements) .40-'-._-4�f___ti�h -. 717 e.-.t0.-�.�+�f.-.��7�t1__.Box _then A0-t'_ l e$Ch_..._---..- <br /> t! t__.line with Dry Well 218 dia. 25' deep <br /> •------------------•----•-----•------------------- ----------------•----------------------- - ........ <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 Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health:Dtstrict. Hong owner or licew <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 become subject orkman' ompensation laws of California." <br /> Signed ..... ..... ...... -V--- --- ------- -• -•--•---------------- Owner <br /> BY -........ <br /> - - ----- ------------ .................... Jitle -- -0wner- :G_.&--0..Septic Tank 9-ere. <br /> II other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ---------- --- ------------------- •- .................. DATE .,J6 <br /> BUILDINGPERMIT ISSUED ---------------------------------------- -- -------------- -. -DATE .............-............................ <br /> ADDiTiONALCOMMENTS ------------ ------ ---------------•------•-• ----•-- ................................. .........---_,.-.............. ........................... <br /> ----------------------------------------- <br /> - <br /> Final Inspection hy: .. �� ' --------------•--------------------------------- ---------------Date f�/r --. ............ <br /> EH 13 2 1-68 Kerr. S SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />