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APPLICATION FOR SANITATION PERMIT (Complete-in Triplicate) Permit No. 7 3/E ................... . -- = ....--- �" ; This Permit Expires 1 Year From Date Issued -7flats � Application is hereby made to the San Joaquin local Health District for a permit to construct and install the work herein described. Yhls application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: 4912 E. Weber Avenue JOB ADDRESS/LOCATION ......S._._..S. de.-of• Weber appx. 53? E. of DelmarCENSUS TRACT Owner's Name G....M....W n.c17eJ..J. 1.. Ox S...............•......_............... ..........•-•...........:Phone ............ .................... Address 8 E. Main Stockton 3 35.......... . ...... ....----....::City .......:.. 5 �........_..__.._......... ....... Rata l�oot�r Sewer Ser 2� 1 Contractor's Name ------------ .........---- -------•-- ---_-_-- --------...................--------.License # ........................ Phone .............................. � Installation will serve: Residence[}Apartment House f] Commercial]]Trailer Court ❑ Motel ❑Other......----••........................................ Number of living units------ Number of bedrooms ---2......Garbage Grinder .yea.:.. Lot Size ....r5.©.3....bt..Z1�5_L............ Water Supply: Public System and name _... if• Water Ser. ---------••----........_------------------------....._....__...........__..............._.__.....Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loom ❑ Hardpan❑ Adobe Ck Fill Material ..._ If yet,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 ] SEPT�2T0q t€IC{_J u Size.... i .i... ------- Liquid Depth ..:.# �!:.:............ 'precast ete 2 Capacity ------ Te _..... Material-------- ----------... No. Compartments ..... Distance to nearest. Well .._.....Length -th of each -line.............Foundation ....1.Q.!........... Prop. Line ...yr'.!............... LEACHING LINE ] No. of Lines I .._._. 1001... ... Total eTth I00 f yes r D' Box T Filter Material rack Type Depth .Filter Material ... 1 �. Distance to nearest: Well _._..n/a........... Foundation ............. Property Line ...... SEEPAGE PIT Depth ._25.'_.•......... Diameter 36 Number ..1...__._ Rock Filled Yes No Q 11 Water Table Depth 5 t �-� .by 3 Rock Size 5 ..........n- -•-- == 1.c.t•---•--------- - Distance to nearest: Well _-_-__Foundation -...... Prop. Line ..:................... REPAIR/ADDITION(Prev. Sanitation Permit# ........................•................... Date ..................:.................) i _ Septic Tank (Specify Requirements) ..........•......................... ................ ..................... ........................ -.:...................... Disposal Field (Specify Requirements) --•------------- --------•-----•-- ........... --------------. -----. ............................. ----- ........ ----------------•---•- ------ = ' ------ ---..•----•-•-------- ------------- - ----- -.-------------------------------------------:f (Draw existing and required addition on reverse side) I .hereby certify that I have prepared this application.and that Ahe want will bedonein accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health:District. Hem• owner or licen- 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 - --------- --------- ------ -- ...... =------------ -------------------------- ------ --.--- Owner BY ---- -- - -- ------•---- - - -----•--- Title ---------- (If other than owner) NY USE ONLY APPLICATION ACCEPTED BY -- .... -• -------=-------- - DATE - -------------- BUILDING PERMIT ISSUED ------ --- --- ---- --- • ----••---• •--- ......................DATE ...------------•----.. -___.............. ADDITIONAL,—COMMENTS --.. ..._. ......... •------- ........................ ....................................:..........•----•--------•-.------------------ -- --------- •. ......--- --------------------------------••-................................ _. .. Final Inspection by: -•------- -- -- -- -- -•---............................•-----.--•----••--..-.__.._---_Date ...��-"" EH 13 24 1-68 OA?" LOCAL HEALTH DISTRICT 8/74 3M