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- .. ..— »vim. ......................................................... APPLICATION FOR SANITATION PERMIT 7�� u (Complete In Triplicate) .,., Permit No. ...7......-...-.... .........».............................................. // _ This Permit Expires 1 Year from Do*isswd Date Issued ..�/l`hS-, Application Is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work heroin described. This application is made in compliance with County Ordinance No. 589 and existing Rules and Regulationsr JOB ADDRESS/LOCATION .........1:010 E. Fremont DoraE. Schaeffer.........................................................................CENSUS TRACT ................... Owner's Name ........................................................................._.......................................... -..-.......Phone ................................... Address ........,1}010 E. Fremont ..................................................................City ..........at.Q.GR.tr.QTI........................_........... ..». ROTO ROOTER SEWER SER. jp.&L (2715 05-2616 Contractor's Name ..................... .................................................................license ........ Installation will serve: Residence 0 Apartment House❑ Commercial pTrailer Court Q Motel0 Other ............................................ Number of living units: ..... Number of bedrooms ......3 ...Garbage Grinder, z1A....... Lot Size .a...&Q.Q.Q......................... Water Supply: Public System and name .........Qallfl„Nater Ser. ........Private0. Character of soil to a depth of 3 feet; Sand 0 Silt[] Clay 0 Pact 0 Sandy Loom 0 Clay Loam 0 Hardpan 0 Adobe® Fill Matorlol .1).Q...... if yes,type............... ............ (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer Is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size.......... .......... .......................... .. Liquid Depth .......................... Capacity .................... Type ...............-... Material...................... No. Compartments ..............._.._. Distance to nearest; Well ....................................Foundation ...................... Prop. Line ..............._.._. LEACHING LINE ( J No. of Lines ........................ Length of each line............................ Total Length 'D' Box ...... ... . Type Filter Material ....................Depth Filter Material ........................................_„p Distance to nearest: Well ........................ Foundation ........................ Property Line .......................0 SEEPAGE PIT ( J Depth Diameter ................ Number ............................ Rock Filled Yes 0 No Q Water Table Depth ................................................Rock Size ................................ m Distance to nearest: Well ........................................Foundation .................... Prop. line ........._.....„._.^ REPAIR/ADDITION(Prev. Sanitation Permit ell ........................................... Date ................................ ) Septic Tank (Specify Requirements( .......................adc ...and... Disposal Field (Specify Requirements) •...................................................._.............:.........--..................................................... .............................................................................._.................................................................._..........v...._.................................... ............................................... ..................•-•---................................... -- ..--..................................................... (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 Regulaticns of the San Joaquin Local Health District. Home owner or Ilan- sod 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 beco e s blect to Workman's mpensation laws of California:' Signed ...- ...__.. ..._.................. .......... .. ........__.... Owner By .... .... .. . ... --- . . ............-..................yitle ------- ................... other than nor) Cont"r&i;'Ctl1*.................... FOR DEPARTMENT USE ONLY APPLICA 10 ACCEPTED BY - Cv.. . -/-avv. .......................................................... DATE .�.G _1. ...... BUILDINGERMIT ISSUED __....... .. ............ ... .......................... ..................... .........DATE .............................. ADDITIONAL COMMENTS __ ....... ...................................".................._..................................._......................................,.... .................._....... ._.... ... _ __..... ------.......,.........----"----...__..."... .........................._....._...—.......................... ..................... ................................. _............. _......1/ .................. Final Inspection by .. ......................................"..Date ._ ....�.......(f.... ................ EH 13 24 1-6 Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M