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- t FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT . ... ..........__. . .1..5�-..[.:Ls. (Complete In Tdpl;este) PWM t No. . ......... .......................... ..... TMYew From Permit Expires I YeFrom Date ltsvW Dab Issued JA 67:7_ Application is hereby made to the San Joaquin Local Health District for a permit to cont n,ct and Install the work herein described.This application is made in compliance with County Oedinarte No. 549 onJ editing Ru s qn_J Regulations: JOB ADDR:'S5/LOCA ON 154-0400-S.e.. CTN....riSQ/VtiD ..._WXT..'WNSUS TRA/fCTf,I/.t/...._...... .._�-_ Owner's Name ..... /BIZ..I.-......X—.Z Xx11V✓r............................--.................. Phone Addross . CBy ,cr . .................. ......._.--.__.-___ _. .......... .......... 12 .. Contractor's Name ... .t/'-........... ..� .. .............License #20.919-.. Phare Installation will serve•. Residence IS Apartment House❑Commercial❑Troller Court ❑ } Motel Cl Other._...... ................................. _ ..... Number of living units: /..... Number of bedrooms ...2.rGarbage Grinder to Sin ...T� .1. ....__... Wow Supply: Pjblic System end name ...............................__...... ...................._......................................Private Cbmacter of soil to a depth of 3 feet: Sand IR Silt❑ Clay ❑ PoW❑ Sandy Loam ❑ Coy loam❑ Hardpan❑ Adobe❑ Fill Material . ...... If yes,type..................._....... (Plat plan, shaving size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: Mo septic tank at seepage pit permitted If public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK I ] Size_ _._....... ..... .. _. __ . . .... . Liquid Depth ........ ......_......_. Capacity ..... . ,- . Type .................... ttrial. .. _ .... No. Compartments ...........___._..v pistons• to neorest, Well ._. .. .............Fou ... _. _. .. Prop. Line ......... ....._.._. LEACHING LINE ( ] No. of Unes ._. . Length o each line .. .. Total Length ....... ..r) Box .. Type Fllter Material pth Filter Material . .................._---..___._- Dts:-)nce to neorest: Wall .. ... ._... ...... .. FO Ion Prop" Line ............_...._.... .. SEEPAGE PIT [ [ Depth ._ D,am. .............. mbe- . Rock Plied Yes ❑ No p Water Table Depth ._. ......_.. .............._. ............Rock Size _.. .. .... .... __. Distance to nearest. Wal► . . ... ...... ..... ................Foundation . . ........ . Prop. Line ........ REPAIR/ADiNTION IPrev. Sanitation Permit sF ...... . ... .. Dab .. ...............................) Septic Tank (Specify Requirements) ...._... ............... ....... .. _I...._ .................... Disposal Field (Specify Requ;mments) ..... . . . ..... . .. __..�. ... .. . .. . t/ (Draw•-isting and required addition on reverse side) 1 hereby certify that I have propred this application and that the work win be done In accardonee with Son Jeegvir County Ordinances, State Lows, and Rules and Regulations of the San Joaquin Local Health District. Nome owner or Brn► sod agents stEnatere c*Mnos the fellewl": -I certify that ;n the Performance of the work for which this permit is Issued, I %hen not employ any person In we manner as to become sebtect to Work" Compensation laws of California.- Sign-d . Owner By 9 < Title 11of other than owner) _JFOR DEPARTMENT USE ONLY APPLICATION ACCEPTED By ZJ � _ - --- DATE /x% / _ ?y BUILDING PERMIT ISSUED DATE - ADDITIONAL COMAIENTS Final Inspection by' (/s' 10064e' Dare 4J SAN JOAOUIN LOCAL n[ALTH DISTRIC' E. H. 9 1--68 Rev. SM