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FOR OFFICE-USE. _ APPLICATIOI R SANITATION PERMIT ..... .......................... .......... .., Permit No'. _ _. (Complete in Triplicate) ............. y s . .. .... ...............:..................... ------ This Permit Expires 1 Year From Da#aued Date Issued _`A``Application is hereby made to the'San Joaquin Local Health"Distrld'for,a permit to construct and Install the work herein t described. This application is made in compliance with Cowity••Ordiriance Nc.' 549 and existing Rules and Regulations: s i Cherokee aad-Hwy: 99 ` JOB ADDRESS/LOCATION ........... - -r. : , ENSU TRACT ..... Del-aldiie Trt"iASa):es j' _ Owner's Name ..............:....••----:............--- .._.._................._........Phone •-----.............:................ Address --•.............................. -'"-- "City's+ �.:: .... ..................... Contractor's Name ROTO -ROOTER SEWER SER. License 91` 2715x9 Phone 465-2616 .....................f....... _ _-___ _._.__-_...._._____.._......................._ ....... ........ ----_...__----.-------_____-__ Installation will serve:'_ Residence p Apartment House 1E] Commercial•13Traller Court 0 ` ❑ ,� Motel Other---•----.. .................. , Number of living units------------- Number of bedrooms ...Garbage Grinder ............ Cot Size ............................................ Water Supply: Public System-and-rivffd ` ......................... . _ :w...........................private -Character of soil too depth of 3 feet: }Sand t] Silt❑ Clay o Peato: Sandy.Loom ij Clay Loam Hardpan Q Adobe Q Fill Material . .bt-.... If yes,type..._......... ............ (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc, must be placed an reverse side.) NEW INSTALLATION: - (No septic tank or seepage pit permitted if public sewer is-available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK f) Size.........!t--by. 5' by` r"" _ 'Liquid Depth _:. 2, ............ ----- .. ....•... :_. 1200 precast concrete ' Capacity ..------'-----_--- Type ------•------------- Material-----_---•--_--- No. ;Compartments ..P.................. Distance to nearest: Well ......RC1`-----------------------Foundation .....10............ Prop. Line ..5......... ._._.... LEACHING LINE ] No. of Lines --------------------- Length of each line.---45�._45�...,..... Tota! ih ......... .... �_.._..M reek f��9 LLIDA.. 'D'-Box .ye .... Type filter Material ....................Depth Filter Materia! Distance to nearest: Well .50-'.................. Foundation 10................... Property Line ..5.1.................... SEEPAGE PIT O Depth --------------_.... -Diameter ---------------- Number ............................ Rock Filled Yes ❑ No T, Water Table Depth • ---------- _-- ...........................Rock Size ......---•.....•.... ........... ' Distance to nearest: Well ..Foundation .................... Prop. Line _, d REPAIR/ADDITION(Prev. Sanitation Permit# _•_.__._.____-- ............... Date .................................. ••- ------------- . Septic 'Conk (Specify Requirements) f �Disposat Field (Spedfy Requirements) ....................... - ••----------............... •••----------•••---•••••--••-••---•.................I.__... ---------------••--- --------------------------- ---- -_--- (Draw existing and.required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin M 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: j "I certify that In the performance of the work for which this permit is issued, ! shall not employ any person in such manner E as to become subject to Workman's Compensation laws of California." Signed ........i! ---- --•-- ----- Owner f p Coz�tracbbr HY :r•=�= --------------------------------- Title _.... (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY Q/ o ...... : .............•--..DATE , ------------ BUILDING PERMIT ISSUEDATE .... ---_--------- ADDITIONAL COMMENTS =..........-.........................-................ _-_--------........ ---------------------------- .... .......... Final Inspection by: ......................... ..... -_._ ................::......... ......•......................._Date ...._. .. .. . . Date ETI 13 .2h 1-69 Rev. 5M AN JOAQUIN LOCAs. HEALTH DISTRICT 8�7h 3M - --