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FOR OFFICE USE. ................. APPLICATION FOR SANITATION'PERMIT {1 ............----1... w m. lCom lete-In Triplicate) _ Permit No. .................. 7S S� This Pon" Expires t Year from.DpN ksued Date Issued ..7/a.:7: 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/LOCATi ' < COf��3...Gey._......,.....g1.�.3._Gar.�..]]r.�.. .......................................CENSUS TRACT .........-................ Owner's Name -..._...._.. Mr. T. Sterling ............................. Phone Address . . ..........: 9 33 Gary City Stockton ............... ............1........._.......... Contractor's Name Rota Rooter Sewer-Ser. License alb .271539 Phone 65.-2616 .......................... Installation will serve: Residencef]Apartment House f] Commercial OTrailer Court 0 . Mote ❑Other ... ............. ......... ,.... !Number of living units:'...Z...__ Number of bedrooms 3 ` ` I -.-..------Garbage Grinder .yes... Lot Size ....................•---.......:.t ........ Water Supply: Public System and name ............... .Private ❑ . Character of soil to a depth of 3 feet: Sand E] .Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan Q Adobe-0 Fill Material ............ if yes,type ............... ............ ' W (Plot plan, showing size of lot, location of system in relation'•-to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: INo septic tank or seepage pit permitted if public sewer Is available within 200 feetA PACKAGE TREATMENT ( I SEPTIC TANK{ ] Size....... ............. Liquid Depth ........................ Capacity --------•---_--•--- Type -------------------- Material...................... No. Compartments Distance to nearest. Well ...........................„ Foundation ......_ .............. Prop. Line __.... ............... { LEACHING LINE [ l No. of Lines _.._..___ __ Length of each linea ..----•--••-- g ,............... .... .... Total Length 3 ' 'D' Sox -----_-.---- Type Filter Material ....................Depth "filter'Material Distance to-nearest: Well -------------------•-:.. Foundation _..............:.------ Property Line ....................... SEEPAGE PIT ,._ . ,:. ,. ( 1 Depth = Diameter lumber ............................ Rock Filled Yes ❑ No Water Table Depth ---------- •-•------•...._...... Rock Size ............................ � • Distance to nearest: Well ._foundation . Prop. Line _______ ....... REPAIR/ADDITION Prev. Sanitation Permit# ... :.. Date ............. Septic Tank (Specify Requirements).------- - Disposal Field a 'f acyl:2. .. - anL.- pits arid'"7e act " 5 i0t5k tYi m•--•---- - �c� WYY often drairis�TYi s tQ x'ep awe-- chs---two---p1t-s•--being......--•---. ------- ----------------cut_-off---by---the__.s.wi.miag- po-Qj,.._i.ras_t� J.t io ..... ................ ------------------------ ---• -------------------------------------- -------------------- ------------.._...--------------------------------------.-------------•............................................... i (Draw existing and required addition on.reverse side) I hereby certify that 1 have prepared this application and that the wgrk will be done. In accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the-Son 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 vb(ect to Workman's Compensation laws of California." Signed -_ Owner i -- By -•--------- - •---- -------------------------- Contractor. .. Title - --• . . .......... ........ l l ter an owned R DEPARTMENT -USE- ONLY APPE_IC TI N ACCEPTED BY d_ BUILD] PERMIT ISSUED _....... ............... DATE ------- ----------- ------------- ADDITIONAL COMMENTS € E = --------------------- ...-----•----------•--------------------------------------------------------------••----..-----:-------- --------- -.. ._- Z_ _ _ Final Inspection by: EH bate 13 2h 1-68 mow' SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M