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FOR OFFICE USES APOUCATION FOR SANITATION PERM ............................ ....... .................. Permit No. 2....7—......../AZ.... (Complete in Triplicate) ........ ......................................... This Permit Expires g.YsorFrom Date Issued Date Issued Application Is hereby made to the San Joaquin Local Health Distiict-for a permit to construct and install the work herein described. This application Is made in compliance with'County Ordinance Na: 50 and existing Rules and Regulations: 40 $ Mile I,Road JOBADDRESS/LOCATION ............. ............•-----._._' . .-•-•----....---...._................._............. ...CENSUS TRACT .......................... Owner's Name ...............Gl. ..t•a1ch........................................................................:::................Phone .................................. Address 490 E. S Mile Road Ci Stockton .. . .......................•------.---------••-•----------------•..------......._..............._:....... ty ............. . . . . . . . . ............... ROTO ROOTER SEWER SERVICE 2715 9 4b :: 6 Contractor's Name ----------- --------------•---••--------.....................---•-•---.........6.. License#`....... ............. Phone .............................. installation will serves Residence❑Apartment House 0 Commercial❑Tra11M Court 0 mote, ootheroffice in home and shop°`outside with toilet &shower ....... -.:...................... yes 6 z acres Number of living units:-........... Number of bedrooms ............Garbage Grinder ............ Lot Size ............................:...:... Water Supply: Public System and name ...................................------ --..._._-._......................................... ............... Private�] Character of soil to a depth of 3 feet: Sand E3 Silt ElClay [3Peat 0 Sandy Loom El Clay Loam ❑ Hardpan❑ Adobe M Fill Material ..rte......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,public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK ] Size....?..tanks: ... ? � ............. .........- qp ....5' 3200 Type ... precast tete .3 Capacity ........... Material.................... . No. Compartments ............ p Distance to nearests Weil ...... .5'0�...........: ..::.Foundation.. .LW............ Prop. Line .....:,5'.......... t 75 •75. 75Length225'................. TEACHING LINE �] No. of Lines ------.3............... length of each line.............�.......r...... Total 18" 'D' Box Yes Type Filter Material ..:.rock...... . Depth Filter Material .........:..:.........:..............:...... Distance to nearest: Well .. .SD.!.............. Foundation .w. ................. Property, Line ..5.'................ SEEPAGE PIT ] Depth ` ..... Diameter A$'_.......... Number ..... ..................... Rock Filled Yes C] No W1lnter Table Depth .........85 �. .... ...:......:..:Rock Size . 2.�byr3�.............. X00 `1�3 �----�--. .5. . ' Distance to nearest: Well .........................................Foundation .................... Prop. Line ................... REPAIR/ADDITION IPrev. Sanitation Permit# .............................;.............. Date .................................. ] SepticTank ISpecify Requirements) ........................---.............` .........................................................................._................ Di'snosal Field (Specify, Requirements) .......................................I............................I.................................. -....._�... .._.. . ....................................... �................. ............................................................................._..----........ (Draw existing and required addition on reverseside) I hereby certify that I have prepared this application and that the work will bo done in accerdamm-With-Sane Joaquin County Ordinances, State !Laws, and Rules and Regulations of the San Joaquin Local Health District. Nasse owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit Is issued, I shall not employ any person its such manner as to become subject to Workman's Compensation laws of California." :)vaned :... ........ :.... Owner } Estimator aYr- / - ...........:......_..._.... . xitie --------...........................-......................_............. if of er than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ........... .. ..��/..................................................... DATE ?� .... BUILDING PERMIT ISSUED r ........DATE .............. ADDITIONAL COMMENTS ................. - ...—.-..... ...... ..............Y/ -------- ----------- .. .�.�..... ..............._ ........- ..............----•---. ......................... ...... . r Final inspection by. ...... ._. .. . Date . _...,?�?.............. EH 1 ............... .. .... .. 2!1 1"6(� �tov• SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3m