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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. 7�- S 3 0 (Completeln Triplicate) . .............._ . Date Issued ......................................................... This Permit Expires 1 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. 5A9 and existing Rules and Regulations: 9000 Orford ...-_-. .........CENSUS TRACT .......................... JOB ADDRESS/LOCATION ..................-.......-...................-------------------------------------- Owner's Name ..................... .._.__-_-..--•---•-..----•-••,----.._................... ••-• _.. ...---........_.._...--•------.---- �,---5-3��--�©r�--•-----------• ._ Phone Address3.7 �..glpin e.........-•----..............-..-•-•---------•..------.....City ................... .....•. ......-•---............... .. .... .-.... Contractor's Name ---.Roto Rooter Sewer Ser.---------------------------------------License * 2$1539 Phone ------------ ---- - Installation will serve: Residence 0 Apartment House Commercial OTrailer Court r] Motel ❑Other............................................ Number of livingunits: Number of bedrooms 3 Garbage Grinder .�e...... Lot Size 1 1/3 acre I ----•--•--•• - .................. Water Supply: Public System and name ..private [� Character of soil too depth of 3 feet: Sand E3 Silt o Cloy ❑ Pent Q Sandy'Loam O Clay Loam Q O Hardpan❑ Adobe 13 Fill Material ..no...._ Of yes,type............... ............ O (Plot pian, 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 ioublliiysewer iisy vgi�able within 200 feet PACKAGE TREATMENT [ ] SEPTIC TANK ] Size......:............... �� Q) ... Liquid Depth Capacity --12-04------- Type ._P-eP,ast Material-P-oricz�ata No. Compartments ..2.................. .........Foundation 10.1...... 5 f Distance to nearest: Well _..�..0.�................ .._....__ Prop. Line .._...._.....:..---•-• LEACHING LINE [ No. of Lines _-- ---•.............. Length of each line._$5'....6,5.'. . Total Length - 1-7jJ.�..........__-.. 'D' Box -5e S-_ Type Filter Material _rock--------Depth .Filter Material _18"_... Distance to nearest: Well ....... 4,........... Foundation 1-Oj................. Property Line .-5.T..... SEEPAGE PIT [ Depth -�5- ............ Diameter 37?r....... Number ._............ 2 !�,qk Filled Yes E] No 0 Water Table Depth 7 � ................................................Rock Size ............................. Distance to nearest: Well ...........................Foundation .......... Prop. Line -5!............... REPAIR/ADDITION(Prev. Sanitation Permit# .._...._.................................................. Date .................................. SepticTank (Specify .Requirements) ...................... ................................................................................ ....------.------•----------- Disposal Field ISpecify 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 Sari 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., 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ............ : ........ - - --- • --- - -----•--------------•-------•-----•- Owner BY ---------• --- •. / ---- Title Contrdctor tf of er than owner FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED, BY -.. .. -- ........................ .. .......... DATE BUILDINGPERMIT ISSUED ....... ------• ------ ---------------• -•-. -------------------------•...........DATE .......................---------- ADDITIONAL COMMENTS ----------------------------------------- --------------------- ............. ------• --------------...---------•----••-- -..:.-.--,_..:-......----... •---- ------- ............ ......------------....-........ -------------------• --•--------------..I�ection by •• ....... ---.....------.. --- ' Final Ins � --••--------•---- r . ...-- ---- - ---.-.-Date r ---•---- EH 13 2h 1-68 ltev. 5m � �SANAQUIN LOCAL LTH DISTRICT' 8/7h 3M