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FOR OFFICE USE; <br /> APPLICATION 601Z SANITATION PERMIT <br />........... .................................... .. Permit No. .. ........-... ..... <br /> { (Complete in Triplicate) <br /> " This Permit Expires 1 Year From Date Issued Date Issued ......... ... <br /> ...... <br /> .v.. r�-c .[�o,r£ " �, 1r <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 /> Mickey Grove Park- <br /> J08 ADDRESS/LOCATION ..--•....................................•--------•--------...------.._......._._ ........................CENSUS TRACT .......................... <br /> .. <br /> Owner's Name Co. of San Joaquin-................................................ ..................Phone .................................... <br /> ------------------•-••---- ......-- <br /> Address 222E Weber Stockton <br /> ....................................1------------.. ..................................... ••...... City ---•--••----•..._........... ......................................... <br /> Contractor's Name .-..RD.tQ..Ro.o-ter ew r---Ser-----------_--------------License # .2.715.3-9 Phone 465--2.6,16........ <br /> Installation will serve: Residence ❑ Apartment House❑ Commercial❑Trailer Court <br /> Motel in Other _shaded pinnic area -facility to wash off plates <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❑ . Silt❑ Clay ❑ Peat❑ Sandy loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe ® Fill Material ------------ If yes, type <br /> W . <br /> (Plot plan, showing size of lot, location of system in relation to wells,,buildings, etc. must be placed on reverse side.) <br /> f <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,} <br /> PACKAGE TREATMENT SEPTIC TANK Size-.... 1 � <br /> � �I c...x._�_,-_:: .r....-..-.-. Liquid Depth -...�-�.-•--•-••--•---- �, <br /> r 1200 recast T CAJete 2 <br /> Capacity ....... Type Material.._'_....:_:::- .. No. Compartments <br /> Distance to nearest: Well ---------. 01-__ lua.......Foundation ..l-0! 1u.s.. Prop. Line .... ' lus... <br /> LEACHING LINT: No. of Lines .....1...- ...... Length of each line.----_--Q-T............. Total L n th 9 .: <br /> _!.......... :......... <br /> yes rock ' ' - l�' <br /> D' Box ............ Type Filter Material ....................Depth 'Filter Material .... ....................... <br /> Distance to nearest: Well ............s.Q!p1J:jpundationlia!...plus..-.. Property Lines.'...pJ_us........ <br /> SEEPAGE PIT { ) Depth25.°................ Diameter -- t'_•..._ Number 1_._..------------•---.-- Rack Filled Yes [ No �J <br /> i i . <br /> Water Table Depth 7-8-F.................................:........Rock Size _lin... 3tt............ <br /> _A <br /> Distance to nearest: Well._...- 1.0.0.!....P1......LFoimdation IQ.'...p1U.S Prop. Line <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ..................l............... Date...........a....................... <br /> Septic Tank (Specify Requirements) ......................... --------------------------------- -------------------------------------7----------------- ; <br /> Disposal Field (Specify Requirements) -----.-------------------------••-------------.....----------------------...._........-----•---- ---- <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 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 become subject to Workman's Compensation laws of California." <br /> Signed ------------ ----- ----- Owner <br /> Contractor <br /> BYj.. ...r. --- •----.. ... ... Title . ...-------- . <br /> er than owner) <br /> FOR DEPARTMENT USE ONLY <br /> o <br /> APPLICATION ACCEPTED BY ,* - .....-...,.................................................••---.----------•--•-.. DATE .._Y. .... .,/ .......I........... <br /> BUILDINGPERMIT ISSUED ...... ---------------------------------------------------------------------------------------------------DATE ........................................... <br /> ADDITIONALCOMMENTS ..........................................................................-..-----...........................--•......................_.-:................... <br /> .. <br /> _.........................--•------ --------.:.. •------- ............................... <br /> E <br /> y . <br /> .................................. ........ --.................................--..........��L A.................­­ <br /> Fina( Ins ection b --• ,t------------ ------..Date ... <br /> ky <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT (' <br /> 7 I 21L, .,- r.. -7 1-7'1 a— <br />