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FOR OFFICE USE: ') FOR OFFICE USE: �� APPLICATION FOR SANITATION PERMIT ------------------------------------------------ ------------------------------ - - � V 7-ld� (Complete in Triplicate) Permit No. -7 -------------------- '< 1 Date Issued-- ---------- ---------------- _ ---- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local HepltF District for a permit to construct and install the work herein described. This application is made in compliance with County Orclinance•No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION-- --------------------2.7-52 -S• R-------------------------------------------------------------- ----CENSUS TRACT----------------------------- - Owner's Name-----Fra_nces_Morgt n---__------ ------ - --------- ---- - ---- ---- ---- - - - - Phone-------------------------------------- - ---------------- - 1527 Stanford Stockton Address------------------- ----- ------------------------------------- ------------- ----- --- City-----------------------------------"-----Zip----------------------------- Contractor's Name----------------------R0T0_ ROOTER S-ENTEM S PWC _License #--2715---------- Ph9 ____" one -ZSlb Installation will serve: ResidenceE Apartment House,.[ Commercial F-1TrailerCourt Elr Motel ❑ Other------------------------ -------------------- Number of living units:-_ 1_-_________Number of bedrooms __;__ Garbage Griner":-,ye,s-__Lot Size----75---x--100_'- __ Water Supply: Public System and name _____ C lif._T-Tater Ser. . __-__-__-____Private El--- ---- ------- -- - - ---- Character of soil to a depth of 3 feet: Sand E] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑" cl-dy-dam ❑ Hardpan ❑ Adobe ® Fill Material_---------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-----------------------------------------------------------Liquid Depth.------------------------ Capacity--------------------Type-----------------------Material--------------------------No. Compartments-------------------------------- J Distance to nearest: Well__-_________--------------------------------------------Foundation-------_------------------Prop: Line--------------_.-________ LEACHING LINE [ ] No. of Lines-----------------------------Length of each line-----------------------------Total Length ___________________________________--- 'D' Box__:_______Type Filter Material--------------------Depth Filter Material______________--___________ _____________________________V' Distance to nearest: Well----------------------------Foundation----------------------------Property Line------------------------------------ SEEPAGE PIT [ ] Depth----------------Diameter--------------------Number--------------------------- ---- Rock Filled Yes ❑ No EllI WaterTable Depth-------------------------------------------------------Rock Size----------------------------------=------------- Distance to nearest: Well------------------------------------------Foundation---------------------- P'r`op: me - REPAIR/ADDITION (Prev. Sanitation Permit#_________-______---------------------------------------------------Date______ _______________________________-__--_) Septic Tank (Specify Requirements)---------------------------------------------------------- -------- __ install appx. 20' ach and 1-42-- d u. --b---25* max. -pit ---------- Disposal Field (Specify Requirements)_ _______ -__ --- _______ __________ _________. s Zz _ ------------------------------------------------------------------------------------------------------------------- ---------------------------------------- ----------------------------------"------------------ ----------------------------------------.----------------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District, Home owner or licensed 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 in such manner as to become subject to Workman's Compensation laws of California." Signed------- Owner BY ------- ---- -------------------------------------------- Estimator -/ - Title------------------------------------------------------------------------ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEDBY =� a1c = f --------------------------- ---DATE `f - - ------------------------------- DIVISIONOF LAND NUMBER ----------------------------------------------------------------------------------------------------DATE------------------------------------------------ ADDITIONAL COMMENTS---------- --------------------------------------- - - - - - --- --- --- ---= -- ---- --- ----------------------------------- �� , � - -- -- -" -- - -- -- -- -- ---------- --- - ----- --- -- -------------------------------------------------------- ------------------------------------------------------- Final Inspection by: --- --- -- Date_ " -,: _ EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV.