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i F OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> n. <br /> ..............—ill �:..- �-' Permit No. ......'f= .. <br /> , 3 -- (Complete In Triplicate) �T <br /> ..�. •may <br /> ........................................................ This Permit Expires 1 Year From Date Issued Date Issued <br /> F Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein <br /> described. This application is made in..complionce with County Ordinance No. 549 and existing Rules and Regulations: <br /> t <br /> JOB ADDRESS/LOCATION 173$ ........Gilcrist .......................CENSUS TRACT <br /> Mr. HopePhon <br /> Owner's Name ....................................................,......I..................... ........_.......:...................:........ ee <br /> .................................... <br /> Address 1738 Gilcrist . City Stockton <br /> ........................................................................................•-- •........ ................. <br /> Roto Rooter Sex License # 271539. - -._. phone .....465•-2616 <br /> Contractor's Nome ------------------------------------------------------------------ --. ..........--- ----. ........... <br /> installation will serve: Residence ®Apartment House] Commercial []Trailer Court 0 <br /> Motel ❑Other <br /> Number of living units------1..... Number of bedrooms -_2`.........Garbage Grinder -n°...... Lot Size A!6 : _100-- .. <br /> Calif. Wnter Ser. ...Private <br /> Water Supply: Public System and name ............ ----------------- ............................... •------••-------------...--•------ ❑ <br /> Character of soil to a depth of 3 feet: Sand.❑ ..Silt❑ Clay ❑ ' Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe ) Fill Material no....... If yes,type ............................ <br /> (Piot plan,,showing size of lot, location of. system in-relationrto..wells,.buildings, 'etc. must be placed on reverse side.{ <br /> NEW-INSTALLATION: (No septic tank or seepage pit.permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ °] SEPTIC TANK fx] Size.............. 4x5-x9........................ Liquid Depth ... .................. -J <br /> M Capacity 1200 yp Precast concrete .. Compartments ................._.:.. 00 <br /> Distance to nearest:_Well .__......_.. ... .................Foundation --- 0.. Prop. Line ..._51ee......... <br /> 1 appx.25feet 25 feet <br /> LEACHING LINE [1 No. of Lines ......t'.r............... Length of each line.._........._................ Total Length ...........I................ <br /> f . <br /> 'D' Box ..Ye .....�Yype Filter Material -,rock..........Depth Filter Material .............. r <br /> � Distance to nearest: Well .....ata............ Foundation .....1Q_.laal.... Property Line 5...£es.t........... <br /> SEEPAGE-PIT- DiametePNumber .1......................... Rock Filled Yes a No Q <br /> 78 feet 1,� x' 3 inch <br /> i Water Table Depth Rock-Size <br /> 10 feet 5 feet <br /> Distance to nearest: Well ..n�a...............................Foundation .................... Prop. Line ....................... <br /> REPAIR/ADDITION 1Prev. Sanitation,Permit# ............................................ Date ................................... <br /> Septic Tank (Specify Requirements) =-----• ...................... ..................... ._..-.-........................_------------------••--._..._... <br /> Disposal Field (Specify Requirements) ...........:.... ......................................................:_...........--•-•-•---------------...------....... <br /> --------------------•--•-----:_....._......... ------------ ...._----- ................ ............................. ........................ ............••--------------------- <br /> (Draw,existing and iequired addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in.accordance with San Joaquin <br /> County Ordinances, State laws, and,Ruies and•Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the fallowing: <br /> "I certify that in the performance of the work for whicls this permit is issued, I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed [ Owner <br /> -------------- - ------------------ ---- ........... <br /> By ................... .. _.......t`/.W. -----------• Title ........Contrar.LOX.......................................... <br /> . <br /> If o er than owner) <br /> F R DEPARTMP#T USE ONLY <br /> APPLICATION ACCEPTED BY .............................. -----------•........... DATE ..... .'A'Z. ...... <br /> BUILDING PERMIT ISSUED ...........------•----••-- ._....:.---- ------•-- DATE _..._.. ............ <br /> I <br /> AXATIONAL COMMENTS . ...._.. ... ................................-._.... .....--•............_.--••----•--........_.................... <br /> ., .�............... . c.: ----------•------ - -..............---...------------- ................................... <br /> 3 .__..__. . .. .. ... ..................... <br /> ......................................... ...... .. ----. .. :............---•-•-:•---............._............. ................_. <br /> Final Inspection by: ....:.. ..........-Date -. ` .... <br /> . l <br /> SA JOAQUIN LOCAL' HEALTH 'DISTRICT <br /> E. H.13 241-'68 Rev. 7/72 3A <br />