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r f' APPLICATION FOR SANITATION PERMIT 7L 5-3 it (Complete in Triplicate) Permit No. ..................... ---_. ........................_.........--•- --•--•--•----•-----•.......... ...... This Permit Expires 1 Year From Date Issued Date Issued .l"?? 7r Li Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work herein described. This opplication is made In compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION . ------------2269 SHollenbeck Road .....-.. .._--.-_. ......CENSUS TRACT .......................... Owner's NameWinchell -- Phone .................................... ....._....._.,c, .---- ..... Address .. - - -3835-- E/ Main--------------------------- ...................Stockton - - ------------- - ----City ..................................................,....-- r Contractor's Name --------- OROOTERSEWER_SFR. Lice Installation #2-715.39---------- Phone .465-2616-,--_.-- Installation will serve: Residenceg]Apartment House❑ Commercial ❑Trailer Court [] Motel (]Other ---- ---------------- Number of living units:-------1.. Number of bedrooms .3___.-----Garbage Grinder ...Ses. Lot Size _.2__agres plus----,------• Water Supply: Public System and name .......................•------.--__. . .....Private r Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay 0 Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe[} 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.) NEV4 . STALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,► ` 1 PACKAGE TREATMENT [ ] SEPTIC TANK [--- �_ f $) Size..4- x, _- �r 9-t _ Liquid Depth -4•�!.............. Capacity ....1200------ Type ----Pre4-SStMaterial.. concrete t 10. Compartments ._5y. Distance 1:0,C11 I . ........_6� Distance to nearest: Well .----------------- ----------•----Foundation -------------- .......... Prop. Line ...................... LEACHING LINE [RJ No. of Lines _2.............._... Length of each line.C�0-1....gQ1........... Total Length ....L8Q!.............. A D' Box ... eS. Type Filter Mate ?I _,rock Depth outer Material _...18'.�. .......... t U 1 Distance to nearest: Well ....................... Foundation Property Line SEEPAGE PIT [)] Depth 25''.._......... Diameter 33A......... Number _-2----------..._....... Rock Filled Yes ® No ❑0 Water Table Depth -------108' t - Rock Size 1K,-i x t 150 n fU Distance to nearest: Well .................... 10 , -. Prop. Lino ........._...........) CF- REPAIR/ADDITION(Prev. Sanitation Permit# ----•------ --- ----------------- Date _ ............................... A Septic Tank (Specify Requirements) .......... . .....-------..................--- ------..............................•. ........ _ r / Disposal Field (Specify Requirements) ------------------- --- -------------------- ------ ----- - -- - -- -- k - ----------------- ----------------------------------- -- -. .........I...... ------ ------------ . -- (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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed -- - ---- -- - - - ----------------- - ------ --------- -- Owner By ..--- . ._ LILT", �. - -'....... Title _coxitraator........ .........._.....----------..-- [ er t an owner) C- OR OR DEPART ENT USE ONLY APPLICATION ACCEPTED BY .. -... _ ., ---` ---- - ------------------- DATE �. BUILDING PERMIT ISSUED .... . _.._ --- ------ ___... DATE ._.---- ---------------._._---- ADDITIONAL COMMENTS ------ ---------- - --------------------- -- . ..... - - ---- ----- ---------- --- --------- ----------------- - -------------- -- -------------- --------------------------- ----------....... - - ----- - ---- ------ ------------------ ...... ..._..-- - -- - --------- --- -_ ----- -.._ _. ...................._.. ---------------- ---------------- --------- Finolinspection by; --------...- ----- - ----- - - -- - -- ----- - --- ...... EH 13 2!r 1-69 Nev. f JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M l V