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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -- -- -------------- Permit No,. (Complete in Triplicate) --------- "0045,7 ------- ------------ Date Issued --��-�2- 3 7 v 7. -_..-___�__�-_-T - .-�_�,----- ----------------- This:PermitExpires 1-Year.From Date issued• r- --•- Application is hereby made to the 5 n,Joaquin Local Health District.,.for a permit to construct and install the work herein described..This application.is made;ri com.pliance"with`County_Ordina_nce.No._549_and-existing Rules and Regulations: i JOS 'ADDRESS/LOCATION ------54'NO-,---Patrick------------------------------- CENSUS TRACT ------------------------- Owner's Name _WTA• 3arker---I-----------------------------------•--------------------- - --- - ------------------- --------- . . -- ------- Phone --------- -,�. ---------- •---- ---. Address ------------S-aIlE---- ----------------- ---------- ------- ----------------------------------- • citY ---- Sto-ckton-------------: --- ------------------ Contractor's ---------------Contractor's Name ---B1aCkard-!�S Sept3_CTonk_---------------___-------.License # _26a-9-51------ Phone --46-3i,-71048------- Instal-lotion will serve. Residence7[] Apartment House,M Commercial ❑Trailer Court i❑ # '� Motel ❑Other -------------Z- ----------------------------- Number of living units:_.__.-_ ._ Number of bedrooms __�___Garbage Grinder ------------ Lot Size ke-re---------------•------_--- Water Supply: Public System and name ----------------------------------------- --------------------------•----------------------------------------Private Character of soil to a depth of 3 feet. Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe'® 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 pyblic sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK I Size------------------------ ------ Liquid -> Depth -- --------------•-------- J. ---.--- }CaCapacity -----'-- =--- Type ---:-------------- Material---------------------- No:�Compartmants •- � I, � w Distance to nearest: Well ----------- -----------------'------Foundation ---------- ___ __ Prop. Line ----------------------- � � = LEACHING LINE [ No, of Lines ____-_---------------- Length of each,line.____�aQ- `- Total: Length 10-0-1- .r.. 'D' Box --------`---- Type Filter Material -----2°--- ------Depth Filter Material ------_ •3 ------------ ........... 11 "k Distance to nearest:.--Well--------- o4___ ____-_Foundation _,__T0_9 .__T '------------- Property Line _-__-4_�__...__--_--- SEEl PIT IE 1, ._---_ Diamete"WkIM-t_ Number -_ _-____.___._.__Rack Filled. Yes ] No (] ,,Depth -_-- Sump Wafer Table Depth ------------------ 4-� Rock Size 2---------j,r------------- [ I Distance to nearest: Well _____________ .Foundation __7fl_f___._ -. Prop. Line _____ ,�r........__ REPAIR/ADDITION(Prev. Sanitation.Permit#-_----------------------------=------------- Date ----------------------------- a � : --=---=---`------- Septic Tank (Specify Requirement's) ------------------------ = f,,_____________ � 4' . eae Fir� xx � � ypis osal Field (Specify Requirements) --------------------- -------- 'X$' fl! Sia m]o- --------------------------------------- ' ----- ------------ ` ---------------------------------- `. ------ - -- (Draw existing and required addition on reVgrse 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.-Horne owner or licen- sed agents signature certifies the following: , . , "l certify that in the performance of the work for which this permit is issued, I shall not employ;any person my such mariner a r as to become subject to Workman's Compensation laws of California." Signed ---------------------------- --------------- -------------------------------------------------•-- Owner By - ------------oe!!Z7 ------- ----- Z-------- Title ----- _-.-.----:,_;;;------- : (If other than owner) � OR .DEPA1tTMENT USE ONLY APPLICATION ACCEPTED BY - _----I-- - - - -------------------------------------- DATE _.Z BUILDING PERMIT ISSUED ------------ --------- - --------- - -----------------------------------------------------•------ -------DATE - ADDITIONALCOMMENTS ------ ----------------------------•--------------------------------------- ----------------------------- --------- ------------- ------------------ -------- -----------------------------------------------I-------------------------------------------------------------------------------------------------------------------------------- ---------------- --------------- -------------- --------- --------------------------------------------------------- FinalInspection by: -- -----------------------------------------------------------------------------------------.Date --- --- -------- SAN JOAQUIN LOCAL HEALTH RDIST RICT E. H. 9 1-'68 Rev. 5M