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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT E ! Permit No. ...7s ..... .....................__................_. (Complete in Triplicate) Date issued --- ...................................... .. This Permit Expires I Year From 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,ln compliance with County Ordinance No. 549 and existing Rules and Regulations: 803 W Howard 4 ................. �k...- -....- `:. CENSUS TRACE I JOB ADDRESS/LOCATION .....-------• ...._-... , Steven A. Kaiser ....Phone ••.......-•••-•. Owner's Name ......... ..... t q 803 W. Howard Ci Stockton ... �,.�7 Address .... ...... ty .. -Roto Rooter SewerSer. 271539 Phone � Contractor's Name ....License # ...._..--•---- .............................. Installation will serve: , 1� Residence jS Apartment House 0 Commercial ❑Trailer Court 0 trailer for agriculture worker Motel ❑Other ..... .................--• •--••• .......no arae age Number sof iiv;rig units:----..'_.- Number of bedrooms ............Garbage Grinder ............ Lot Size ..........................................-. Water Supply: Public System and name _......._... -----------------------••-------••-•-------------•------••-private [ .... s Character of soil to a depth of 3 feet: Sand I Slit❑ Clay,❑ Peat® Sandy Loam ❑ „Clay Loam 0 � Hardpan ❑ Adobe 0 Fill Material ...1.Q.... if yes,type --------•---------- in ------- _ i buildings, etc. must be placed on reverw'side.} (Plot plan, showing size of: lot, location of system in relation to wells, „ , I NEW INSTALLATION: (No'septic tank or seepage pit permitted if public sewer is available within 200 fe11 et,).1 .I X ' x 9' - ( ] SEPTIC TANK 1x] Size.......... ....5........._...........__....__ Liquid Depth � ti PACKAGE TREATMENT �! qq concrete 2 12UQ precast .. Material No. Compartments ...................... V!i Distance to nearest: Well ..5a!- ____------Foundation _..1D'_...._.. .. Prop. tine 5.!.................... If .... Len th of eat�i line.. 0.Q..................... Total tt�� $�h 100.--..._....._. Ell -D':'Box of Lir1es 1 9 1� TO -------------------• roc o E •••_....___ Type Filter Material Depth Filter Material ......................................:.:... 1 LEACHING LIN No.' Yp ••--,---••'-""- � e Distance to nearest: Well ..50;............... Foundation_--1IIa.---_-----••--Property Line '---••...............• �! SEEPAGE PIT f�0 Depth( -------------------- Diameter ................ Number ............... ...... Rock Filled Yes ❑ No C3 O'� Water Table.Depth Rock Size ................................ 19 Pro Line Distance to nearest: Well ...Foundation p• •••••• ............. i REPAIR/ADDITION(Prev. Sanitation Permit# .............................................. Date ............ ..................... Septic Tank (Specify Requirements) ......................... ....... Disposal Field {Specify Requirements} ........................ j __..._.--•-----------------------........................................ ii ---....... -•........................... . — ... ..__ ................................................... (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 Reguiations of the Sdn Joaquin Local Health District. Home owner or licen- I 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. €I as to become subject to Workman's Compensation laws of California." i' Signed ------p': Owner F Joe White - Title ....0°ntracto ...................... By ..__....... ................................ ..•---•----•- (if other than owner} I O DEPARTMENT USE ONLY i DATE # APPLICATION ACCEPTED BY :.. ....... /..e- --------------------------------••-•----•-- � : :.. . BUILDING PERMIT ISSUED / ...DATE -.... • �•--•.............. ADDITIONAL COMMENTS: _. L.L . ....................................... .........................._............................-••------• ... ....................... ._.. _ ' ................................ .. ' _... ':-- ....i � .. . ............ Date •-•-- - .... _._. .... ................... Final Inspection by: f� . i SANAQUIN LOCAL HEALTH DISTRICT �I 7/72 3 IK �1 c u 13 24 1_-An v.,, AA _ _