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FOR OFFICE USE: SANITATION PERMIT <br /> APPLICATION FOR Permit <br /> ................................I.................... (Complete in Tsiplitale) <br /> Date issued <br /> .......... ...........-.................... his permit E r xpiros I year From Ocito 1511109d <br /> ................................ <br /> ealth District for a permit to construct and install the wo <br /> Application is hereby mad to the ton Jooq6in Local H <br /> I rnpl*once with Count No. 549 and existing Rules and Regulatrk heroin <br /> ions' <br /> described. This applicotiton'Is made in co <br /> M <br /> JOB ADDRESS/LOCATION SUS TRAC <br /> T ...... ............------ <br /> ................. ...............I............19 N. Filbert ...C <br /> ................Phone ......... ................ <br /> Owner's Name ....... Stockton <br /> arne ..... i�La---Ro CL f-ilig................................ 5---2-, '16.......... <br /> Filbert...........4...................... Ci 2 6 <br /> .......... . ............7-1 5T4..... <br /> Address___.................... .11..... <br /> Roto -Rooter Sew. Ser. ........... ............ <br /> .............. Phone ... <br /> Contractor's Nome --- ....... ...... ........... --------•................ Commercial Court (3 <br /> 'Residence 0 Apartment House{ <br /> rcl I <br /> Installa serve'. <br /> motel []Other . .......................... <br /> Garbage Grinder ..........'-Lot Size .......................................... <br /> Number of living uni _..!I. - <br /> its: . Number of. bedrooms ............Garb - ex ....................Private 0 <br /> Water Supply: Public Syste and name ........................................... kat <br /> ;i Peoto SondyLoamO ClayloamO <br /> Character of soil to a dept. of 3 feet- , Sand 0 Silt 0 Clay 0 <br /> Adoben <br /> Fill .........If yes,type ............. ..... <br /> Hardpan 0 must be placed an reverse side.) <br /> (plot plan, showing size lot, location of system in relation to wells, buildings, etc. le within 200 feet) <br /> Nit permitted If public sewer is avoilab <br /> NEW INSTALLATION- 0 septic tank or seepage P <br /> Size.....................I.............. ............ Liquid Depth ........................... .00 <br /> PACKAGE TREATMENT SEPTIC TANK I I <br /> ...................... No. Compartments ....................... <br /> Capacity -------------_------ Type ----------------r..... Mater Prop. Line ....................... <br /> -0 Well .............•.......................Foundation ...............I...... <br /> Distance.to nearest: <br /> ......... Total Length ............................ <br /> No. of Lines ............... ... Length of each line................... <br /> LEACHING LINE 11 11�1 <br /> t), Box ...... Type Filter Material .....Depth Filter Material ........................ ................... <br /> ....... Property Line .............. ......... <br /> Distance to nearest- Well ....... .......... dation..... Foun ....... . Rock Filled Yes 0 NaN <br /> . <br /> SEEPAGE PIT C 'epth _...... ........... Diameter ................. Number .................... <br /> ............ <br /> Water Table Depth ....... ................... ....... <br /> Rock Size ................................. <br /> ............Foundation --- Prop. Line ...................... <br /> Distance to nearest. Well ..----._------•--•-------- <br /> .I' ................... ... .............................. <br /> REPAIR/ADDITION I Prev.ipanitation Permit# <br /> . Date..............I....... <br /> ................ ............. <br /> Septic Tank (Specify 6quirements) t'ffzi ecTe ................ <br /> 1�: I <br /> Disposal Field (Specify Requirements] <br /> .. ................................................... <br /> ........... <br /> -------•--------•---------------------•-.......•---••-•-••-•-••••- <br /> ----• <br /> ................... <br /> -------­---- .......... ................ ............. ..........................I................ <br /> .........I------------ ----------------• <br /> ------ ---------------- ------------g and- - required-addition on reverse side) <br /> J�, 6� ,(Draw existing <br /> I h � that the work will be done In accordance with San J604ulln <br /> I hereby certify that ;aV prepared this application and n jacquin local Heal&DIstrict. Home owner or 11con- <br /> County Ordinance&, Stat i& taws, and Rules and Regulations of the So <br /> sod agents signature certifies the Following: <br /> "I certify that,In.the performance of the work-for which this'permit is issued: l shall not employ any person In such manner <br /> as to become subject to:Workman's;Compensation laws of California." <br /> Owner <br /> Signed ----_----_- -- --------- ... . ----------- ------------­ actor <br /> Contr ............ ...... <br /> .................. Nitle ... --------- -------------- ....... ........ <br /> ------------------- - - <br /> BY <br /> her than owner) <br /> R 611E <br /> "A - NY USE ONLY <br /> DATE --- ............... <br /> -----_----------------- <br /> APPLICATION ACCEPTED BY ----- ------ DATE ................................. <br /> BUILDING PERMIT ISSUED ------ - ------- -- ---- .......... .... .......... ....... ------------- <br /> ADDITIONAL COMMENTS ---- --- - --- ---­-------- ­ ------- ...............I.............. ------- ........ <br /> ------------:------------------------- ---------------------------- <br /> -------­-------- --­-------I--------- <br /> .........................---------- ----------- - - ----------------­ ­----I----------------- ---- <br /> - I ---------- ................................... ------ ......... <br /> ----------- ...... <br /> -•----------••`----------------­-- ----- ..............Date ...... . ..... <br /> '�specfion by: ----------------­ -------------------------------------- <br /> final I <br /> 8/7h 3M <br /> EH 13 24 1-68 V_ 5M SAN JOAO IN LOCAL HEALTH DISTRICT <br />