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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---------��i--�-�>--------•--------------------- Permit No. .7 S77�'4fl (Complete in Triplicate) -------------------------------------------------------•- ____-__-_-_-__________.___--___------------- This Permit Expires 1 Year From Date Issued 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: JOB ADDRESS/LOCATION __?55_.Sq.__Adrienne._St._..__.____CENSUS TRACT .......................... Owner's Name --------------Duane---7,baOR-_Realty- --- ------..Phone 951--2581................ Stockton Address ------------------------ City ------------------------------------------------------------------------- 466-960 7 Contractor's Name ---------a.--A.--Parrish-c.--Sans Inc•----------------------License # ------------------------ Phone -----------_------------------ Installation will serve: Residence)M Apartment House❑ Commercial ❑Trailer Court i❑ Motel ❑Other __.----------------------------------------- Number of living units:_3--____ Number of bedrooms _IV-----Garbage Grinder _________ Lot Size __!1 !X3Z_t_------------------------ Water Supply: Public System and name ----------------------------Ca-l'ifor-ni.a--Wat�-r--Z.vC- -------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Gay ❑ Peat❑ Sandy Loam ❑ Clay LoamI 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 ...................... Distance to nearest..,Well ------------------------_-----------Foundation ---------------------- Prop. Line ...................... LEACHING LINE [ ] No. of Lines ------ ------------ Length of each line-------------.-------------- Total Length ,--------------------------- U1 'D' Box -------- Type Filter Material --------------------Depth Filter Material --------------------I....................... Distance to nearest: Well ________________________ Foundation -----------------------. Property Line ---------- ............. kA SEEPAGE PIT [ ] Depth -------------------- Diameter ---------- Number ---------------------------- Rock Filled Yes '❑ No i❑ Water Table Depth --------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --..---_------.--..-_______----___) Septic Tank (Specify Requirements) -------------Existing---------------------------------------------------------------------------- ,._-------------------------- Disposah-Field (Specify Requirements) ------aupplementas7►---Drainage---------------40---1.f._leaching-_ mAn------------------- ----- --._.--------.�' ---------------------------------------------------------------------------------------------------------------------------------(') 33" x-25'...seepage Pit.------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- (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 licen- sed agents signature certifies the following: "1 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 orkman's Compensation laws of California." Signed -------I�� IS & SS s hTC- BY --(--/- -------------- ------------------------ Title .-Es_iiimator-------------------------------------------------- (If othe han owner) FOR PJ MINT USE ONLY APPLICATION ACCEPTED --- -------- ----------------------- ------------------------------------------------ DATE _ BUILDING PERMIT ISSUED -------- ----- DATE ------------ -------------------------------------------------------------------- -------------------------------- ------------------- -------------------- ADDITIONAL COMM ------ -- --------------------------------------------------------------------------------------------- ------ ------------------------- - ----------------------------------- - - -- -�- i-------------------------------- Final Inspection by: -------------- - -� -- -----------------------------------------------------------------------Date --- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M