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s ArrLICATION FOR SANITATION PERMIT S Permit No. ...... S.. (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 Regulotions: 2269 S. Hollenbeck Road JOBADDRESS/LOCATION --------------------- ........................................ ....._......... .................... Owners Name ......Jimmie...Winc.�P.11-- ............ ................................_..........._....... . t%=. Address ... ------------------- 3835 E/ Main Stock o ..................... -... --.. . .. ....... ... ......... - City Contrador's Name ---------AQT . R00TO WEW-SER......-----•...............liense #2353 .......- Phone -kk : 266 Installation will serve: Residence ID Apartment House❑ Commercial oTrailer Court Q Motel []Other---------- ............................. Number of living units:------.1.. Number of bedrooms .3.........Garbage Grinder ...Ygs. Lot Size . ............ Water Supply: Public System and name ... ...... .......................... ............- - .............. .....................Private Ig Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay o Peat o Sandy Loam ❑ day Loam ❑ Hardpan O Adobe 0 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.) NEytf;INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) ` I PACKAGE TREATMENT [ ] SEPTIC TANK$j Size-41...5._51---x--9-1.-------- - .-_ Liquid Depth _l{ !.................�/ Capacity ..-.1200 Type reYNG merial.. concret1 0�o. Compartments ---2T.............� Distance to nearest: Wel[ ....................................Foundation ...................... Prop. Line ..............-_..... LEACHING LINE [A No. of Lines .-2............. ..... Length of each IlnegO-!----gal....... ... Total Length ....1801..............N 'D' Box ...Y09- Type Filter Materl9l -_rock_.-_-..DeptFl iter Materia[ ....18_�..... 10 -5.1................. Distance to nearest: Wel[ ......ell........... Foundation ........................ Property Line ........................� SEEPAGE_ PIT (g) Depth 2-5,!----- ---- Di ber ....2......................-.Mock-Filled Yes-a--No 00 Water Table Depth .......108507..........................Rock Size ... .0.7 x..X°......... - 5 r N Distance to nearest: Well ........................................Foundation .................... Prop. Line ..................... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ...-...-........................ SepticTank (Specify Requirements) ...... ....... ......................................... ......................._..................................................... Disposal Field (Specify Requirements) ..................................--................................................................................................ ---- .._-........-......----------- ...............-............... . (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, 1 shall not employ any person In such manner as to become subject to Workman's Compensation laws of California." Signed - ---------- ----------- - ----------------------- Owner -------------------- ----- Brie ..0ontrac.tor.------ ------- ...._. By -------- -------- -`-- - --- - - - ( er t an owner) c OR DEPART ENT USE ONLY APPLICATION ACCEPTED BY -.. -- . . ..... - ..- --------------------------- -- DATE BUILDINGPERMIT ISSUED ... _--- -- --------- .............................................. --------------- DATE - . - .................. _..... ... ADDITIONAL COMMENTS --. - -------- ------------ ----- - - -...............• _. - ---- --- --- --------- - - .-.----- ----- ------ _.......---------------- .... ........ ----- ---•----- ------ ................ ....-.......... ........------- -- ------ --- -- -- --- - - --- -----P---------- -----...---------------- ---------- - ------- ....................................... Final Inspection by: ---------- - ----------------------- ......Data .... yi-- ---- . EH 13 21t 1-6f1 Rev. 5HJOAQUIN LOCAL HEALTH DISTRICT 8/711 3M