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FOR OFFICE USE: ' FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ............. . . _ .... . Permit No..�. -/�".S {Complete in Triplicate) _.._..._ I Date Issued... "_7� .................... -- .. -.-.J This Permit Expires 1 Year From Date Issued 1pplication is hereby made to.the San Joaquin Local Health District for a permit to construct and install the work herein described. 'his application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: OB ADDRESS/LOC ION.....�g�„�.. .__ .. . .._5.c.. a/Y1-- 1...Dr I......�CGQ6l..CENSUS TRACT.......... . .............. .... ?wner's Name .. .�. _.. .. ....:. ... Phone... 57..J ..... . address... 1-7N �.. ---- Ci .. . ty_�..�..�..�-ice,._. . . ZiP_.. 'ontroctor's Name.D. ..................License #..25-- Phone nstallation will serve: ResidenceApartment House ❑ Commercial ❑ Trailer Court Motel ❑ Other_. ............ ..... ..........._ . Dumber of living units: .._ .. ..._.Number of bedrooms ....... ..Garbage Grinder.-----------Lot Size......... ...... Vater Supply: Public System and name .... ................................... ................................Private ❑ .haracter of soil to a depth of 3 feet: Sand ❑ Silt[] Clay ❑ Peat ❑ Sandy Loam Clay Loam E]Hardpan [-_] 1� Fill Material.. .... ... If yes, type.......................... .. . Slot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) IEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) . d 'ACKAGE TREATMENT ..I Liquid Depth.._:__�_7...._............ Capacity.. Y ..T\ype rr Material.Cc`rx� .._.No. Compartments.._.....��.................. Distance to nearest: Well .. ... Q.O...T............. .. ...Foundation....(.Q .•.......Prop. Line...«.."r.... .... EACHING LINE ) No. of Lines Length of each line ------- _..._.... ... Total Length .. ... . 'D' Box. . Type Filter Material........ __. .....Depth Filter Material........-----------. Distance,to nearest: Well ..�........ .......... Foundation............................Property Line................................... . EEPAGE PIT (� Depth......4.__..Diameter_s�..o....Number... _._________________ Rock Filled Yes No❑ 36",Y Water Table Depth---------------------------------------------------------Rock 5ize...(. �l .X.�.�Y...... 1` Distance to nearest: Well.. .100.-r . .......Foundation.. .1D. . Line...1. ....... EPAIR/ADDITION (Prev. Sanitation Permit#....................... .......... .... ........Dote.............................................. ) r epticTank (Specify Requirements)...... ..... ........ ..................... ... ............. ....................-- /........................... ...... .... .....4....Q� ........ )isposal Field (Specify Requirements).......`��'`'�'f/'� --�.... ---____ _ /S .. .. . . ... 74 ...............- ... --. .............. ---............ -- -----------•------- - _..... �..� C (Draw existing and required addition on reverse side) hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County )rdinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Horne owner or licensed agents ignature 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 become subject to or m },'s Compensation laws of California." U. Yf RRISH & Sot ��i�t.. Owner i ed._ : ...- Sot BOi{ 1456 IY- STOCKTONr--CALIFORNIA--93201. . . Title---_ . . . .. ............. (If other than owner) FOR DEPARTMENT USE ONLY \PPLICATION ACCEPTED BY... ... .... DATE . . +. ".. ................. NVISION OF LAND NUMBER. ........ ..........DATE..... ...... .. . ...... . ............... kDDITIONAL COMMENTS.._..............t!.......... . ........................... .• ...... .............. ..... . . . ............................................ . ............ ........... ..... .. ....... .. ..................................................................................................................... .........I........................... :.......--.......... ....... -•............................. ......... . .................. ....... :incl lnspecilon by:...... `L� Date . ............... H 13 24 "�<�' y..': CAAI Ir1Ar1111A1 AI uCAIT4 MCT01rT F&S 2167Y%EW 7/763M