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FOR GFF€Co USE <br /> L (`aP' -LICAT16N FOR. SANITATION P Iii <br /> ':.:.... l qy� Permit No. _Z,Z-.. <br /> ................: _1 <br /> til 1Complete in Triplicate) <br /> .................-...... <br /> .. <br /> This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work herein <br /> described. This application is made in compliance with County Ordinance No. 5.49 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION79H N. -... echer Lane ..........CENSUS TRACT -------- ................. <br /> Be•....................•--•--------­---........ <br /> Owner's Name .........T. WakeLbayaski ..... . .........Phone ..........._.............. <br /> ..s aid6.................................----------•--------- <br /> Address _ .... ...... ........................................____------ City ..............27.i�� 9.- .. .. .--- ......-_1�65_2616"- <br /> ..---- . <br /> Contractor's Name --- x..Rooter---Sewer der• ............License # ........................ Phone ...._..... ............. <br /> Installation will serve: Residence 0 Apartment House❑ Commercial❑Troller Court ❑ <br /> F '+ Motel ❑Other <br /> acrs <br /> Number of living units:--.]........ Number of bedrooms ._-.3_-----Garbage Grinder ......_.... Lot Size ............................................ <br /> Water Supply: Public System and name .............. .......Private <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam❑ Clay Loam ❑ <br /> Hardpan Q Adobe o Fill Material ..1'l.Q..... If yes,type ............... ............ <br /> #Plot plan, showing size of lot, location of system in relation to 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,) ri <br /> ' PACKAGE TREATMENT [ ] SEPTIC TANK{ ] Size................................................ Liquid Depth .......................... <br /> Capacity -------------------- Type -•.................. Material........-............. No. Compartments ...................... o <br /> Distance to nearest. Well ....................................Foundation ----- ................ Prop. Line ._..............._.._.7 <br /> LEACHING LINE [ ] No. of Lines _______________-_ g g <br /> ------- Length of each line---------------------------- Total. Length ............................ . <br /> 'D' Box ............ Type Filter Material ....................Depth Filter Material ............................................ <br /> L <br /> Distance to nearest: Well ........................ Foundation .................. Property Line ........................ tt <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ...........----------.------ Rock Filled Yes No <br /> 11 <br /> Water Table Depth ................................................Rock Size ------......I............. <br /> . ... <br /> I <br /> Distance to nearest: Well ........................................Foundation ------ ............. Prop. Line ................... <br /> REPAIR/ADDITION Prev. Sanitation Permit # .................... : ..... ........... Date ----------:--.-- ............... <br /> Septic Tank S(Specify Requirements) ------- ..........add-- s-�P-----•----•-•------I- <br /> -------------- -------................-- r <br /> A <br /> Disposal Field (Specify Requirements) -_--to_ existinu _septic system <br /> .' <br /> ---------------------------------------------------------------------------............. ------....-................•---•------._........... ---•--•--.......---------------._............--------------- <br /> 1 ------------------------------- -....--- --•--- ..... .......---- --------------------------- ................ <br /> (Draw existing and required addition on reverse side) <br /> 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 Rules and Regulations of the San Joaquin Local Health,District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> l "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> + as to become subject to Workman' Compensation laws of California." <br /> Signed ---- -- -- Owner <br /> Contractor <br /> < By ........... Title .------------------ -------------- ............... ........ <br /> (If other t an ow r <br /> + F E ARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY _.- - - ---------------------- -- --.----. DATE <br /> BUILDING PERMIT 'ISSUED -.----.. ..-. ...-.:---. -- DATE ..... . <br /> ..__... <br /> ----- .. <br /> ----- ----- -------------------------------- .......... --------------- <br /> ADDITIONAL COMMENTS --- -- ------ ----- <br /> F- ---------- <br /> ---- ---------------------- <br /> ........................ ............ <br /> ---- -- ------ <br /> - ------__-------. ..................... ------------ -- <br /> ---------- ----- -- -- --- -------------- ....................................... ......... ... ..................................... <br /> Final Inspection by.� ------ - . __'". ..�. .. .--_------•-------- ----------- -------------------Date .. ..3.—�Gr. �/. --._..-- <br /> EH 13 2h 1-66; ,5'i ,-AN�'J `jAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />