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FOR OFFICE I,JSE: APPLICATION FOR SANITATION. PERMIT 1 (Complete In Triplicate) Permit No. _ �_-.1, _... . r This Perms!Expires VA� Date Issued .3:�� 7t p res 1 Year Front pats Issued . Application is hereby made to the San Joaquin Local Health District for a permit to construct and-Ans#all the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .......579s._N. Beecher Lane ......-----•........................•-..........................:.............CENSUS TRACT T.. WaI�abayaski ..... Owner's Name ._--....-•--•-.s"am... Phone ----•-------- ......................•--•--.. .,........I....................... ._• Address .. .......................... Contractor's Name ....___.. Soto Rooter Sewer Sex'. 53—9- 4b �b1 ........ -----•--•................................•---•...••. Licensed .. Phone Installation will serve: Residence P Apartment House f:] Commercial oTraller Court ❑ Motel [].Other Number of living Garbage Grinder I acmes un�ts....�._.__._. Number of bedrooms .... ...._ Lot Size Water Supply: Public System and name _.__.... ..................._... ......... .._ .............................._...---.�:......... .............__. ....... Private Character of sail to a depth of 3 feet: Sand O Silt O Clay ❑ Peat O Sandy Loam,ij : Cldy Loam Hardpan ❑ Adobe.0. Fill Material if yes,type............... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.J�. NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANK Size..................... __---- Liquid Depth -1 Capacity e 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 ............ . Distance to nearest: Well ........................ Foundation ...... Property Line SEEPAGE PIT [ Depth ...--...._-_-.--- Diameter ..........:..... Number ................-------,.... Rock Filled Yes ❑ No Q fb Water Table Depth ..... .........................................Rock Size Distance to nearest: Well ......................... --...Foundation .................. Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# t- ` ' ' " ..:" ----•------------------- --- Date ........ ) Septic Tank (Specify Requirements) .................add-..Z-6--'----m:,8.L_:.by--a-fl ' Disposal Field (Specify Requirements) ----�O...existing _septic system ; ....... -------------------------------------------------------------------------.........------ ------------------------------------_.-•-•-- ._....v... ---i-. ... (Draw existing and required addition on reverse sde) 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 Regulations of the San 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, I shalt not employ any person in such manner as to become subject to Workman' Compensation laws of California." Signed -------- . Owner BY Contractor .. ----- - •----------------• Title ----------------------------------- (If other t an ow r - E ARTMENT USE ONLY APPLICATION ACCEPTED BY ------ 1 •-•----------- -•-- --------------------- DATE BUILDING PERMIT ISSUED - ----:-•-- -- -- ------------- ---------••-- --------- ---•-------------------• -----------------DATE ------................................ ADDITIONAL COMMENTS "...- . ......... ••---••--•--•-----— ---------------------- ................................ •----/ - Q - -.-. - --1-- --•----•-------------- -------------------------------------- --------------- .....-. _.---- _ _ r ------------ ,. -----------------------•------••-- _._ . final .. _ ........----------•- -----------------------------------•.------------ ............-........._.-.__.......-. EH 13 Inspection ecti 1-613 ----,..Date . :-/.f�.;7 . AN JOAQUIN LOCAs: HEALTH DISTRICT ,8/7h 3M ,J