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f' <br /> FOR' SE: APPLICATION FOR SANITATION PERMIT <br /> R• Permit No. .. fjl:./._'� 3 <br /> ....... ........ ..�............•._. __._..___...____._____._ 1 .. l <br /> (Completo tri Triplicate) <br /> This Permit Expires Z Year From Dot*Issued Date Issued �/-/r 7� <br /> ..---"..................................I... -- <br /> Application is hereby made to the San Joaquin Local He- lth, District for a permit to construct and Install-the'work herein <br /> described. This application.is.made in compliance with County Ordinance-No'. 549 and existing .Rules and Regulations- <br /> 2 qtf 3 <br /> egulations:25f`f3 Lc _ r - " ccs 7` <br /> JOB ADDRESS/LOCATION Nor h West Corner of -and-and­ <br /> _.-._ <br /> ..........CENSUS TRACT ...,....r............:.... <br />` Owner's Name ..._Jimmie Winchell .i phone ..---•............:.:.........-.._.- <br /> -- -----• --------•..----.... <br />! 3835 E. Main Stockton <br /> Address .-.............. --•-- :.... ...........:..............................:..------------ City _.............-...:..........-..................._...................... <br /> ..._ <br /> Roto Rooker-Sewer Service '271539 465-2616 <br /> Contractor's Name _____.License # ....I................... Phone --•--......:........-.-.....-- <br /> Installation will serve: Residence p Apartment HouseO'Commercial❑Trailer Court ❑ f <br /> Motel ❑Other : . <br /> 1 3• .. ...... <br /> 1 ,'.("" <br /> -,Yes ,- 70'x 140' j <br /> Number of living units:............ Number of bedrooms ..........__Garbage Grinder ............ Lot Size ..............,. <br />' Water Supply.. Public System and name R ;F+ <br /> Y ---._Ca�.�.f_...��aii�x...Sex-.....................................................................Private ❑ <br /> Character of soil to a depth of 3 feet: Sand o Silt❑ Clay ❑ PeatCf Sandy Loam'❑ Clay Loam ❑ '; <br /> Hardpan Adobe Fill-Material .=i:?4..... If yes,-type............................... <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse s€de.)'. <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public.-sewer is available within 200 feet,) 11', <br /> L 7 V� 4-x5-x9 ' Liquid Depth . -4�1PACKAGE T.REATMEN7 SEPTICTANK Pre CasS�ze........ ............ .:...... .........-- <br />' Capacity1200.' ---- TypeConcreto---- Material..concrete.. No. Compartments 21 <br /> --- •----•............... <br /> Distance to nearest: Wel) N/a- __._..___.Foun.dation 10' .Prop. Line 5 <br /> ...................... <br /> LEACHING LINE No. of Lines -.4Z.................... Length of each line.... �'._.an4*I-_ Total Length 3-70.................... <br /> yes rock. 1$11 5- <br /> V Box ....____-- . Type Filter Material ....................Depth Filter Material .......................:....:............... <br /> Distance to nearest: Well .............n/a.... Foundotiom 1Q-`.-................. Property Llne,_5.. ............... �1 <br /> SEEPAGE PIT ) Depth2z---- ..---- Diameter ..33:: ...!. Number ........................... Rock Filled Yes No (3 ry <br /> Water Table Depth __97.°....................................Rock Size ..1' "...hy..3.'.'.._:.....__ <br /> Distance to nearest: Well ..n/a..........'.....................Foundation......,........ Prop. Line ..5.......-------- <br /> .-- <br /> i <br /> REPAIR/ADDITION(Prev. Sanitation Permit ql-` ----------.-----------------------•-____---- Date ••--------------------•------___--) <br /> Septic Tank (Specify Requirements} -.1.........................................-......................... I............ <br /> Disposal Field (Specify Requirements] .-----...... I .... .................:......................................................... <br /> ......------------------•------------ ................... -•------- --•-. ............... <br /> ` ---------•-- ................................. <br /> ... <br /> -------------------------------------------------- -- <br /> (Dr6w existing and.required addition on reverse side)' <br /> I hereby certify that 1 have prepared this application and that the 'work will be done In accordance with Saiz Joaquin <br /> County Ordinances, State Laws, and Rules--and-Regulations of the San-Joaquin•Local--Health:District. Home owner or licew <br /> sed agents signature certifies the following: <br /> "I certifythat in t performance of the rk for which this permit Is Issued, I shall not employ any person In such manner <br /> as to become su e t to Work C s ion laws of California." <br /> } „/ e <br /> Signed ----------- --- -- ---•--------.-...--- -••- -` ------------.....------'--- Owner <br /> BY -•------------ ------ ----Joe.sph V. kihie - .._._ ._. . Title Contr.actor <br /> ............................ <br /> other than owner). . .. ._ , <br /> ! �R DEPARTMENT USE ONLY.- <br /> APPLICATION ACCEPTED BY ___ -- - ....... T--- <br /> DATE ,.Ir �-7 ---------- <br /> - <br /> BUILDING` PERMIT.-ISSUED-_----------- ---------__- ...................................................-:-DATE -------------•---- -----........-- ---- <br /> ADDITIONALCOMMI=NTS•_'------•---'......................•------•-•-------------------- - -.-.--.---------------------------------------------------------------------•---- <br /> ------------------------•- -------- ---- -----_... --------............................-•--. ._................. ._......... ...---•-.. <br /> -------------------- <br /> ...-•-- -------------- -- -. - -- • .---...------------.-. ..�_._ g <br /> FinalInspection by: .---------- ------ ------- -----....................._.......... ..........................Date --" .......`....._._.. .......-- <br /> EH 13 24 1-68 Rev. 5M SAN JOA WN LOCAL HEALTH DISTRICT 8/7h 3M <br /> C = <br />