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FUR DFFICE USE: APPLICATION FOR SANITATION PERMIT _ (Complete In Triplicate) Permit No. 7S ......_� _-- This Permit Expires i Year From Date Issued 4 Date Issued .��_. 7 r 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. 549 qnd existing Rules and Regulations: JOB ADDRESS/LOCATION .......... N •Ts..BRA�SHn R SLQ(�7 L- ? �� ...........................I......._..__....----........CENSUS TRACT Owner's Name ................•-___--• tock'l+on 0 .�4ts.. au -•-•-- .......5..., ----Phone5*"'s $ ------- Address ................:...... _...2067.-4--:7-t14.,StMt..:-................... City .....3.t�4gktoA Contractor's Name ......................31,.J ,--Perish.&.$QLs.�}1g.....____..License # ......... .... . ..!52!!96Q7 Phone Installation will serve: • Residence 9WApartment House 0 Commercial❑Trailer Court 0 Motel ❑Other I` Number of livingunits:.... Acerae �_._-- Number of bedrooms ....._.Garbage Grinder .._ Lot Size ................................. i Water Supply: Public System and name ...01=0=1s3..bTaJC.,SVge..............Private ❑ : Character of soil to a depth of 3 feet: Sand]] Slit❑ Clay ❑ Peat 0 Sandy Loam ❑ Clay Loam OC Hardpan I] Adobe ff Fill Material type (Plot plan, showing size of lot,-location of system in relation to wells, buildings, etc.'must be placed on reverse side.) NEW INSTALLATION: JNo septic tank or seepage pit permitted If public sewer is available within 200 feet;) PACKAGE TREATMENT f ] SEPTIC TANK IJ Size................................................... Liquid Depth Capacity .................... Type Material.................. ;No. Compartments ...................... 6 Distance to nearest: Well ..........__. ..........Foundation ...................... Prop. line J LEACHING LINE [ ] No, of Lines ..................... .. Length ofeach line'_......:.......... ... Total Length _.. 'D' Box ............. Type Filter Material ....................Depth Filter Material ....... Distance to nearest: Well ........................ Foundation . Property Line SEEPAGE PIT f ) Depth Diameter .... Number i Rock Filled Yes [3No 0. - Water Table Depth ......................... ....:..............Rock Size ................................ E Distance to neoresf:'Well ........................................Foundation .... Prop. Line 1 .REPAIR/ADDITIONPrev. Sanitation Permit# { ........................................ bate ......................... . Septic Tank (Specify Requirements) ..........:... Disposal Field (Specify Requirements)............. x ..., it ft leach. drain-. � ..............................•--•----......._.................--- ....................................L..........:........................................................... (1 3 '..d a,�..• .-25x._-deep..seepage.:pzt..,......_l_3}i..............................................rsinn bog existin drain to remain active} &---....•--••-•-----._..........----•---ct (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 Regulations of the San Joaquin Local Health District, Home owner or Reetw sed 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 become subject orkpnan's Com ensation-1 s of California." Signed ..... By _... .......................:.......... . . ¢y...... Title .....Estimator I (If other than owner) FOR DEPARTME USE ONLY APPLICATION ACCEPTED BY ......... .... / . -- -•....:. GATE .__/.�-l4.....Z ...........::.... BUILDING PERMIT ISSUED .............. . .... .. . .. ._s..........DATE ........................................: ADDITIONAL COMMENTS _.....-.-- ................................................................ =........ .._._. . . ._...._....._............ ... ....................... '. .... .._ ........................ ................................... ............_....I........ ....._.-•-.---•................. final Inspection by —� �......� �- ...__.. . Date , „~'l.�c SAN JOAQ�LOCAL HEALTH DISTRICT r�u-13 24,t-,.&a a— _..