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APPLICATION FOR SANITATION PERMIT �` s'J ............I ......... - - I T (Complete in Triplicate) Permit No. ........_............ 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: 2269 S. Hollenbeck Road JOB ADDRESS/LOCATION ............. ...................... ....... .. -.--..._.. -.....CENSUS TRACT ._..__-_..............- Owner's Name . - Jimmie._.Win.c..hell. - - .. . Phone ............. - .....- . Address -3835 E/ Main Stockton --... -- - -- ------ - -------------------------------- -- city Contractor's Name ---------ROW...ROOTERSEWER_SER._-------- ----------_,_.License ; ?.Z153.9.......... Phone .1165_-2616 Installation will serve: Residence]Z]Apartment House 0 Commercial❑Trailer Court Motel ❑Other Number of living units:----- Number of bedrooms -3-------- Grinder __..Y.es. Lot Size _2--_acres---Plus-_.__••-_._ Water Supply: Public System and name ------ --------------••--•------------------------------------------•-----_- ............................Private Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay loam ❑ Hardpan ❑ Adobe ll Fill Material .n0...... if yes,type .......... .... ............ r, (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW 1,I'ISTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) ` I PACKAGE TREATMENT [ ] SEPTIC TANK$] Size._ �...x--. !...x._. .!................ Li uid De th ._ !. 1 ` � q P !k ................N Capacity ...-1200------ Type preibbtMaterial_, concreteNo. Compartments ...ST.............6� Distance to nearest: Well ....................................Foundation .----_.......--------- Prop. Line ..-.._-----.-------_ LEACHING LINE [A No. of Lines _�.._.....____.... Length of each Iine40.!...:OO_!........... Total Length ....18AS..............� 'D' Box ...des. Type Filter Mate ?I -_rock_______Depth10Filter Material ..._18t� 5 ' Distance to nearest: Well Foundation Property Line .....------.............y SEEPAGE PIT [)d Depth 2..51............. Diameter 3311..._..... Number -_2.............___....... Rock Filled Yes [3 No ❑i Water Table Depth _......1085 r Rock Size ..h�.i -.... . 5 Ip 1 0 10 Distance to nearest: Well ................ __.--...-Foundation _.......... ........ Prop. Line ........._....... REPAIR/ADDITION(Prev. Sanitation Permit# .................. ......................... Date ..................................) p Septic Tank (Specify Requirements) . .................... ......................................................... ........................... ......._-----------........ Disposal Field (Specify Requirements) .____. ............... /// --------------- -------------- ------------------ - ----------- - -------------- ------------ ---------------- --- ............ ---------- ........... .................... ------ ------M___-------M-------- - --------.------- ----------M---_------------------ —----------------------_--------------------------------- -------------------------------- . (Draw existing and required addition on reverse side) I hereby certify that 1 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 .---------_- ---- - ------------- -1--,-- Owner By - �✓ 'c ------------- -------------- Title .-Con-tr.ac.tor---------- - _------------- ` ( er t an owner) c OR DEPART ENT USE ONLY APPLICATION ACCEPTED BY .. 77 BUILDING PERMIT ISSUED ......_.---- . . . ----- ---- .. DATE _ .-_L._ ----------------- L. _ -__....-...GATE -----COMMENTS ........- .. - ----- ....... - - - ---- - -...._....__... - - - -- - - ---------- -- - ------ ---------------- ------------------ ----- -------- ----------- ..... - --- - -- -- - ..... ......... - ---------- ---- - a'- --- - r. --:-------------------------_- ------------ ----- ------ - -- --- - --- -- ---- - .._...._---- --------- ------- - - -- -- - Finallns Inspection ._.._..._....Date _--�...........��- �---�- P 8 Rev. - - --- ---- __---------------- EEi 13 2!! 1-68 Rev. jM JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M