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FOR OFFICE USE: l ` 3 4 APPLICATION FOR SANITATION PERMIT {Complete In Triplicate) Permit No. .7........ ...... pate lsswed...: :�f�-76.. l ......................................................... This Permit Expires ] 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 incompliance with County Ordinance No. 549 and existing Rules and Regulations- JOB ADDRESS/LOCATION 1529 S. Walker Lane �._....__...................... ...........................CENSUS TRACT ..._.........:..:......... Owner's Name -----Mlit--cuneo--- ------- --- ---------------......_................ -•...... ......:....................Phone ................. :. Address .......1529 5. Walker Lane City __Stt�.ckton......................:- .. ---- Contractor's - . e -- ...__... ................. ........................._.. Contractor's Name Roto Rooter Sewer Ser. 271539 4b5-2616 License ......... .............. Phone .................._.. Installation will serve: Residence ID Apartment House Commercial OT'railer Court 0 . Motel ❑Other......_ .........................•. : Number of living units:---- ----- Number of bedrooms . 3 Garbage Grinder _..yeS.. Lot Size acreagg .... .... .... Water Supply: Public System and name ..------------ .......... --._--..............._._—.........................Private El Character of soil to a depth of 3 feet: Sand[] Silt 0 Clay ❑ Peat❑ Sand Loam Clay loam E Y fl Y ❑ Hardpan p Adobe 0 Fill Material ............. If �type ea a............... Y (Plot plan, showing size of lot, location of system In relption to wells, buildings, etc.. must'be placed on reverse side. NEW INSTALLATION: (No septic Itank or seepage pit ,permitted if public sewer Is available within 200 feet,) 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 line............................ Total Length 'I)' Box Type .f=ilter Material ....................Depth i Filter Material Distance to nearest: Well ........................ Foundation ----...------........._. Property Line- ._..... ................ SEEPAGE PIT [ }' Depth ----_-----_ Diameter ---------------- Number ---.:--:- .-_........... Rock,titled Yes ❑ No Water Table Depth ...Rock Size ......A7�......... - Distance tolnearest: Well .................... .................Foundation ..__......__...--... Line ....:........._.._.... REPAIR/ADDITION{Prov. SanitationlPermit c# ...:........................................ ©ate ...... ..................... •:-_-•-� � —• Septic-Tank (Specify .Requirements).__........_ ....................................................................................... Disposal Field (Specify Requirements) ...........--Add..suMPp-.to--.exist.iUg--lGac-h.-Iin-e---------.':= fC.-:=__..__ ----.•....--------••- .............................. ..•----•------ --•-• ------------------ ------------------------------- -- -•--- --- - ....:......::. :.:....._...-----•---..__...:_.._.. •--•--•.................... (Draw existing and required addition on reverse side) 1 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;Dlstrld. 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, i :Ball not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed -------------•--••-------- -- ----- Owner --------••--------------- --------• ----------- ----- Title (I# o#het n owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..__�1�' . a-r -•----•- -- - -- ------------=---- •--•----------------------DATE ........ BUILDING PERMIT ISSUED ..-- DATE_ ...... ADDITIONAL COMMENTS ............................................. . ------------- ------------------------------- -.. ---------•-------- Final Inspection by: --- ' --•------------------------•-------------------------...--------..------------Date _._._....ice. -------��?..--•----........ EH �` 2h 1-68i d` "�Y ' SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M