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("' ,�+�� Pl'� ..,,� , .•�PPI�tCATIC?N FOR SANITATlSN PE. ;iT. .._... ...-----...K1_ Permit No. .� ::% _ '. tl�� (Complete in Triplicate) Date Issued " 7 . .� -------.•.......:.......:.................•..---_-..._ This permit Expires I Year From Onto 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 in compliance with County Ordinance No. 544 and existing Mules and Regulations: [ ....................... CT .......................... JOB ADDRESS/LOCATION ......_5798 _N. Beecher CENSUS TRA T. WELkabayaski Owner's Name ......................................Phone ..._.._........._............_...-.. I F! Add re's s City ... 27539 Contractor's Name oto Rooter Sewer der. License Phone Installation-will serve: Residence 0 Apartment House❑ Commercial❑Trailer Court Ft Motel ❑Other ............... ...................._...... 3 -- ac P s Number of living units:_-I-- - Number of bedrooms Garbo a Grinder � Lot Size ............................................ Water Supply: Public System and name -------------•-.........................................-_....._._...........__.............................Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam❑ Clay Loam ❑ Hardpan ❑ Adobe g Fill Materlal ..aq..... if yes,type ............... ............ f } (Plot plan,-)showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) k NEW INSTALLATION: !No septic tank or seepage pit permitted if public sewer is available within 2110 feet,] PACKAGE TREATMENT [ ] SEPTIC TANK[ j Size......................................... ...... Liquid. Depth ..................... S Capacity ----- Type ... Material...................... No. Compartments ................... d Distance.to nearest: Wel! Foundation .. Prop, Line LEACHING LINE ( ] No. of Lines ----------------- ------ Length of each line---------------------I....... Total Length ..__.... ................... , 5 D' Box Type Filter Material .......Depth Filter Material ............................................ t Distance to nearest: Well ........................ Foundation ........................ Property Line ........................ SEEPAGE PIT [ Depth -------------------- Diameter ................ Number .... ....................... Rock Filled Yes ❑ No Q ' Water Table Depth ----........................-............Rock Size .............•................ -- Distance to nearest: Well ..Foundation REPAIR/ADDITION(Prev. Sanitation Permit# ..------------------------------------------- Date .-................................ s �i Septic Tank (Specify Requirements) add-.-Z-6_!..:.x..8�.l._.by.--1fl.!...s�R..----••-----••-•----•----...__.----------........:.:.... Disposal Field (Specify Requirements) __._to existing septic system ------------------------....................... , t� _ (Draw existing and required addition on reverse sidel f. 4 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 cigents signature certifies the following: "I certify that in the performance of the work for which this permit Is issued, i shall. not employ any person in such manner as .to become subject to Workman' Compensation laws of California." Signed ------. Ownercontractor By - --- - --- --- - --- ------------------------------------- title llf other# an ow r F 4E ARTMENT USE ONLY APPki BUILDINGPERMIT ACCEPTED BY - - ---------- ----- - DATE ..._. -/11. PERMIT ISSUED -------- ---- .. ----------DATE ..... --------- •=•----- --•.._..,.---. ADDITIONAL AI_ COMME TS ----- ------ -.._- ---- - ------------/-- •------- ------ -- -- - ------- --- - --- ------- --•--------•-------------------- ------------- --------•-- ---------- -------•----------------- - --- ? f --- --- - --------------------------•-•-------•----------....----------------------------....---.. -----••----------- -------.----•--. � . �lIe' ction by: -- ..... Date .... EH 2L1-61AN }QAQ!iN LOCAL HEALTH DISTRICT 8/7h 3M