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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -2---JW---------------- ---- &!/-x � 77-�/6 ------------------------ NX Date Issued-,,;?---.---------- -------------------------------------------------- This Permit Expires1 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: 103 N. Adelbert JOB ADDRESS/LOCATION------------------------ ------------------------------------------ -----------------------------------------.CENSUS TRACT-------------- ------------ Owner's Name-------Mr._and Mrs Luman ---------------------------------Phone--------.--------------------------- Address-----------------------103--N.---Adelbert-------- - ------------------------------- City-----Stockton-----------------------Zip RRROTO ROOTER SEWER SERVICE 291739 Contractor's Name---------------------------- ------------------- -------------------- -------------------License #----------- ----------------Phone--- ------------------------------ Installation will serve: Residence a Apartment House.❑. Commercial ❑ Trailer Court ❑ Motel ❑ Other-------------------------- ----------------- Number of living units:_.l__..------Number of bedrooms.r`e_-.._Garbage Grinderyes_____Lot Size-_75x100 Water Supply: Public System and name -_----_- Calif. Water Ser E]----------------------------------------------- -------- - -------- --------- -------- ---------- - ---- -- ------Private Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe R] Fill Material---no-----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---------------------------------Z Distance to nearest: Well--- ---------------------------------------Foundation--------------------------Prop. Line---------------------------- LEACHING LINE [ ] No, of Lines-----------------------------Length,of each line__._.,-.___.____._..______Total Length.______------------------------------- F 'D' Box Type Filter Material--------------------Depth Filter Material--------------------------------------------------------------J Distance to nearest: Well----------------------------Foundation----------------------------Property Line_______________-_._______---- SEEPAGE PIT [ ] Depth_.--------------Diameter--------------------Number-------------------------------- Rock Filled Yes ❑ No Water Table Depth_-.-----------------------------------------------------.Rock Size---------------------------------- ------------- Distance to nearest: Well---------------.--------------- -----------Foundation--------------------------Prop. Line_______-____________--_-. REPAIR/ADDITION (Prev.Sanitation Permit#_-- - ---------------------------------------Date----------------------------------------------- Septic _ ___ ___ ___ ) Septic Tank (Specify RequiramePAQ.__ _ ------add appx._ 10-to_ 15}�"of::leach__ixid-_�__ "__bY_ 25' seepage pit Disposal Field (Specify Requirements) :'--------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------- (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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed-------------------------- ---- ---- - - ----- ------------ Owner ESTIMATOR By------- �� Z�' `� !LL-. Title - - - - -- (If at�Y� t w ) DEPARTMENT USE ONLY APPLICATION AC EPTED BY____ _ ____DATE __1_-`1- - - ---------- -------- --------- --------- --------- --------- -- - -- DIVISION OF LAND NUMBER = ,' - DATE----------------------------------------------------------------------------- - -- -- ADDITIONAL COMMENT l�-yyr----------- Z ---- ------------------------- -- - --- - -- -- - -- - - ----- - ---- ---- -- ------ ------ --- - --- ---- - - --------- -- - ------ - - - - ---- FinalInspection by:-------- --- ----------------------------------------------------.__..------------ ------------------- EH ___ .EH 13 24 i S JOAQUIN LOCAL HEALTH DISTRICT 'Fas 21672 REV. 7/76 3M