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FOR OFFICE USE: . U APPLICATION FOR SANITATION PERMIT .....I - .- mss—/7� {Complete in Triplicate) PerrP0 Vo. ..................... •---••--- 3-d " Ali -------------------------------- This Permit Expires 1 Year From Dot*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 ......__5.09.N_.....Qr'Q.......................................................:..................CENSUS TRACT .................•........ Owner's Name Gene Wright .. a.va1 .e ............- ..Phone ...... ............................ - fix' '._. . Address _..... ..--- P. O. Box 1891 City Stockton . ............ .. .... ......................................•---......_......_.._...... Z71539 Contractor's Name :Fiat_o..Ro.o.ter---S.ewer.-.Sex.................................License # ......................... Phone .............................. Installation will serve: Residence [3 Apartment House❑ Commercial ❑Trailer Court 0 Motel ❑Other ............................................ Number of living units:------ Number of bedrooms ........3..Garbag4 Grinder ---y.(_, Lot Size _______________•-..---------_.- ............ Water Supply: Public System and name ----------------_____ alif_.,... _Ater.-Scr_.._...._............-_ - Private ❑ Character of soil to a depth of 3 feet: Sand . Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam Hardpan ❑ Adobe ® Fill Material ......na. 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] r` PACKAGE TREATMENT { ) SEPTIC TAMC f ] 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 .-..-_.----•-------------_.- 'D' Box ------------ Type Filter Material .....................Depth Filter Material ............................................ - F Distance to nearest: Well ........................ Foundation Property Line ........................ , SEEPAGE PIT [ l Depth •___________________ Diameter ................ Number ____.___ ................... Rock Filled Yes ❑ No 0 Water Table Depth ...Rock Size *^ Distance to nearest: Well ........................................Foundation .______..._ ........ Prop. Line ------------- REPAIR/ADDITION(Prev. Sanitation Permit# ........._.................................. Date ....--------------.---------..--_:I Septic Tank (Specify Requirements) ..........................................................................................................................-- -- Disposal Field (Specify Requirements) ........................Ld-d. ---to--.e -i_sti-ng...___.___._ system ------------------------------ ---------••------------- ------------ --- -•-•----------....... ....................--1------------------------ (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 lows of California." Signed --... Owner By ...................... . .. Cont .......................... (If oth -tha owner] FO5 DE T NT USE ONLY APPLICATION ACCEPTED BY . = = DATE .....3....z..-1.?.."-------------- BUILDING PERMIT ISSUED ........ ................................................................................. ..---.....DATE ...-.-.---................................. ADDITIONALCOMMENTS ..................................................................---......----•-. --------------......-- ------------------------------- ..__............ -----•------------------ ....................................... --------•-•-----• ...................................................... ------------------------------------ ------- - ----- - ----- ----••------..... --•-•-----•----- . ---•- Final Inspection by: . � _.... - ._..--•-••---•-•...........................Date ..... ... .........`...X I......... < SAN JOAQUIN LOCAL HEALTH DISTRICT ) E. H.13 241-'68 Rev. 5M 7/723M