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APPLICATION FOR SANITATION PERMIT ��/ ..........................'............................ a - (Canrpi ti iii Triplicate! Permit No. .2Z.�...` ` -:......................... .......... This Permit Expire:l Year From Date issued Date issued ;3.:.�.. 77 i Application Is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work herein. described. This application Is made In compliance withCounty 9dinance No. 519 and existing Rules and Regulations, JOB ADDRESS/1:0_ CA ION v`:' .� : Owner's Name ..... . ............... r ............ CENSUS TRACi'..............:............. kAddress ®. - .. ty ne .......... f Contractor a Name ;�4' 7...-- License ..................... .......... ... _ Phone ,�E. ,nl Installation`will serves Residence^Apartment House C] Carriinercial QTrailer Court E] Motel-Q Other...... ...................................... Number of living,units,.._....Z Number of r ._�.....Garba a Grinder Cat Size .. �1...>�.� ........... Water Supply, Public System and name ,��c�� ... P� ._...._. .._-----•..........................................Private Q u Character of sail to a depth of 3 feet: Sand Y] Silt[] Clay Q Peat❑«. Sandy Loam Q day L:aam 13 I : Hardpan Q Adob&A Fill Material ............ A A ................ If yea.type........... 0 (Plat plan,'showihi size of lot, location of system In refotlon to wells, buildings, etc. must be placed an reverse side. NEW INSTALLATEONs !No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( 1 SEPTIC TANK Size. _ C.----1�� Elquid Depth .... .................. 4 Capacityl G_4ekl Type - ._.__.. Material. _ No Compartments .Z..... i Distance to nearest: Well' ��./�e......Fou ation , �- ._..... Prop. Line.. ...... ..... oe LEACHING11NE No. of lines ,tan gth of ach ine- ....._..... Tota! Len th ��...�.-.-•---• ' 'D' Box '�`. ....._ ..._�.k... � .De Depth lit Type Filter'-Material .., p Filter Material >. .�,�............................I Distance to nearest: Weil; G:GJ..... .. Foundation-1.ola............... Property Line ..4.....�..... SEEPAGE PIT Depth ��/..... Diameter ,.` �. Number . .� . . .. . Rock.Filled Yes ` Na tWater Table-Depth .....p�-�--.....--•• .....Rock-Size .o ...........'./ance4onearest, Well •- :-- ..,...Foundation :. Prop. Eine ..3r� f...- ..REPAIR/ADDITION(Prev. Sanitation Permit L.� - ©ate ..............•----- =. . dtSeptic Tank (Specify Requirements) ....................................... ....^.__.- --- •-- .,...._...._........... ......................._........Disposal Field (Specify Requirements) ..........................._...--- ........-..._._.°........................_..._ ...................................j ......... _. _.'...--.q•••__ _ -_........................__.-.. ..T..._--.._.............._. ..........t.... .j. .r.........._,.....r....... ...--............ ._.__...........y......_.. .............:....._.. .:..r........._.........._._......_....---..........._.. A ' ......._......._.... lDraw existing and required addition on reverse sidel � ' I hereby certify that i,have prepared this application and'that the work will Iso done M accordance with Sats Joaquin County Ordinances, State Laws;and Rules and Regulations of the-San.Joaquin Local Healih Dlstrict. Home owner or licen. sed agents signature certifies the fiillowings A "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 svbi4ct to Workman's Compensation laws of CallEarnla:' Ct,;c�P�CE'S S3 PLIC SEWEP SERVICE Signed .... -�n..=..� ... ......_ - flvvner -26.3-5o. fora F Stockton, Cali,. 95205 , BY ... l-1 .... .... _ "w..�� h.?" v t+ �tef's E�c..�267-1.77, a Title . t. ..: f if other than ownerj� _—FOR-DEPARTMENT-US!:-,ONLY. ._. F ..--APPLICATION:-ACCEPTED-BY..� : .._`r�.d .................................................. DATE ..,.. BUILDING PERMIT ISSUED DAT,: .-""'�::".................... "'-•' _ ..----------•.................................... .... ................-•-----......... ............- ADDITIONAL COMMENTS ...............L-... . .. s -........ ........I'll... ............ -.. ..... .. .- .................. -•...... ........................•-- ................ . ! ._"I.........- ............................... .. ... ...... ....... .--••--.•......-•---... ........................... ..... ........... ................ .... ....1..._. .. ...........: . - ..............-........_....Final Inspection by � .......--•---•..... ... . .. ....................-.�' _ ....._-.... = EH 13 24 1-68 Rev. 5M i SAN JOAQUIN LOCAL HEALTH DISTRICT $� h 3M