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APPLICATION FOR SANITATION PERMIT -,, _ (Complete In Triplicate) ................. . ..® Date Issued This Perone Expires I Year From Date Issued Application is hereby made to the San Joaquin local Health District for a permit to construct and Install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: 925 Bryan- r v JOB ADDRESSAOCATION ------- - - ...----•-•-- CENSUS TRACT �.... . ......... .. ---........---••--••--•••............................ ......_. .._... . ....... Owner's Name ... Collins ' ...... ...................................................Phone ................................... Address 1231 W. Robinhood Dr. city Stockton -------- ................ -•- I---•-----------._..._....---•-------•--..............Ci ----------------------------------------------- Contractor's -••----.--- •--------- r Contractor's Name License �715�3 Phone'.465:7.2.6,5 Ro o...Roo-ttr Sewer ..... b .-.2b1.6......... Installation will serve: Residence f]Apartment House Commercial QTrailer Court 0 Motel ❑Other Number of living units:------ Number of bedrooms ...3---._.Garbage Grinder ?�o..-.... Lal Size ....5a�.�. 100 Water Supply: Public System and name � er.......... � . ate ❑............... ......................Pr Character of soil to a depth of 3 feet: Sand b Silt p Clay 0 Peat Q.- Sandy Loam p Clay Loam ❑ Hardpan 0 Adobe b 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 1s.ova liable-with In 200 feet;J PACKAGE TREATMENT [ ] SEPTIC TANK J ] Sloe. ....................... Liquid. Depth ..................... -------------------- Type ------ ............. Material_. ............. No. Compartments' ..-- .......---.... Distance to nearest: Well. -.-•................................foundation ....... ........ Prop. Line ._..........-........ . LEACHING LINE [ J. No. of Lines .....................: . Length of each line..................... _.__ Total Length 9 'D' Bax ............ Type Filter Material ....................Depth Filter Material ............................................ Distance to nearest: Well ............:........... Foundation _....._.__......... .... Property Line ........................ SEEPAGE PIT [ ] Depth Diameter ......... ..... Number . ... - ------- p .......... Rack Fitted Yes ❑ No Water Table Depth ..--••..........................................Rock Size ................................ Distance to nearest: Well -----•--•---•----•......................foundation --- ................ Prop. Line -------------......... 39 4 REPAIR ADDITION(Prev. Sanitation Permit# ..................................... Date ..........._............... ( j Septic Tank (Specify Requirements). :....... _aa 's'um to ... _................. Disposal Field (Specify Requirements) ------_-------......... _- ._ existing gystem as best as possible ...... . ' Back yard is so sma1-- that----o___Q.t]ger.._rapair.:.ia..po-s&i•bls-.................... ----- _..................................................... --- ---- -- •-- .......................................... . (Draw existing and required addition on reverse sidel 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 Loco! Health.#3istrlct.Horns owner er Ifeen- ' sed agents signature certifies the(ollowing: "I certify that in the performance of'the work for which this permit is issued;I,shaN not-.emplay-any-persor: #n such manner as to become subject to Workman's Compensation laws of California." Signed - -- -- --•-------- - ----- - Owner . BYlf . Title ..-.C_ontr.act.or_... If other than owner) f FO EPAIUMENT USE ONLY APPLICATION ACCEPTED BY __. . --.- -DATE . BUILDING PERMIT ISSUED ---------/-�• � ----------------------------------------._----------------_---.DATE -------.------ ............. ADDITIONAL COMMENTS -'-__.__.//—4M---------------------------------------- ---•--•--- --------•-- '7� Final Inspection by: -e- wRl--- �/z��•,�--- -------------=-•--•--...-------•- - - L- ----_--Date i/��y�7/.—............. EH 13 22t 1-6Rev. 5WSAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M 4