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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT _._.__................................... Permit No. \ (Complete in Triplicate) „--.--_-•,--__••-,.•---•..•...--.--. This Permit Expires 1 Year From Date Issued Date Issued ..7�............. 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: JOB ADDRESS/LOCATION ..................._.........1635•.S—Adelbert.................................-........CENSUS TRACT .......................... Owner's Name Mr. P. Cullison .............Phone 1635..5...Adelbert............................................ ........ .Stocktc►n Address ----•--------------- ---------------•--•-•-••---.........._.................................. City ....----••---••---................................................ ...... Contractor's Name .....R©to._Rooter_ Sewer. Ser...........................•........License # .271,5.3.9.......... Phone .465.72616........... Installation will serve: Residence (3 Apartment House❑ Commercial ❑Trailer Court 0 Motel ❑Other ............................................ Number of living units:-_..1..... Number of bedrooms ......3....Garbage Grinder .Y.es.... Lot Size ..69-x•- 2Q...,.•......••.......... Calif. Water Ser. Private Water Supply: Public System and name ......................•--.............---••-•••-•--••-----.........._.............•---.......__....... ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loom ❑ Clay Loam ❑ 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........4 4x5-9 quid Depth ....!"i..... Capacity ....8W.1200rype •Precast... Material..... No. Compartments .. .................. Distance to nearest: Well ........as/a.....................Foundation ..........Loi...... Prop. line ..;5'................. LEACHING LINE No. of Lines ...1................... Length of each line.......40.................. Total Length 40' . w D' Box no -._ Type Filter Material ....................rock Depth Filter Material ..1$.....................................� Distance to nearest: Well .........n/a........ Foundation .1:0 1.................. Property Line 5.'................ .._.. SEEPAGE PIT [ Depth --Z5............ Diameter .....331.t Number ..... ..................... Rock Filled Yes ff3 No p V% Water Table Depth 78' ............R..................Rock Size 1 by 3•.......... Distance to nearest: Well n($ ...Foundation .......... Prop. Line 5 REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .......................---------.} !Y Septic Tank (Specify Requirements) .... ........................ Disposal Fey (Specify Requirerr�ents) Bathroom system is separate and on North side of home a -------•------••---•---.---.--•-•..............................................•....•............. .............................Ib wit rains running ue east. --- -----•------•--...----••.................•-•-•-•--........•------•---....----•.....-•--•----.......... .................------._.... .....-•---•......••--•..._...... --------------------------------------------------- ........................................................_............................................................................................ � (Draw existing and required addition on reverse side) 1 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 licen- sed 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 Contractor B .� � Title a er'thon owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY......7,40.1 ......... DATE ......... .. L BUILDING PERMIT ISSUED .................. - -......................................DATE ........................................... ADDITIONALCOMMENTS ..................................................... .............................. ................................................ ..............................................•--•-•.............•--....................................................................................................---.......---..................... ........................•--•-._..._....._............._... :. ...-..........._Date........ .. ... ..... ...... Final Inspection by: 1l .. r SAN .)OAQUIN�LLHEALTH DISTRICT L3 24 7/72 3 M E. H. 1.•68 Rev. 5M