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FOR OFFICE USE:--'- APPLICATiON FOR SANITATION PERMIT �! 3 ( � Permit No. ...... --•=--.•--•- a .--- -•------- _�.... s r._. _ _ ........................... (Complete in Triplicate} -..,�,..-_ _..-_....... .,�... ......:............................ ...._ _ Date Issued .. .............. 5 >F Expires I Year This Permit Ex From Date Issued /....... p �.. . , .� ict for a it to l the Application is hereby adelto the Son in compliance withln Local aGoulth nytrOrdinance Nom549 and exxiistting Rules tand Regulationsfein described. this application ......... ..... .......... C .�......... ......................CENSUS TRACT - JOB ADDRESS/LOCATION .� 1 .�..... ..... ;.. ...... ................... .......... hone t. Owner's Name .. i �_.. ..City ....l�. cr ................ Address . ... ....../,. %1-7. -...::.l- ir _. 6D�. Contractor's Name ............ .:..::............itcense ._..... Phone installation will serve: Residence AP ment HouseO Commercial❑Trailer Court fl r"<.Motel Q c) er........................................... 3 Garba a Grinder Lot Size ..... .._.. '�=` ........ w Number of Irvin units•..... Number of bedrooms 9 Private k Water Supply: Public System and name --------------•-•-- -- _..._..........._....:..._................................................... 4 ` Character of soil to a depth of 3 feet: Sand n Silt❑ Clay ❑ Peat❑ Sandy Loom 0 Clay Loam Hardpan❑ Adobe❑ Fill Material ............If yes,type............... ............ Y - (Piot plan, showing size of 'lot, location of.sysiem in relation-to welli,'buildings; etc. must be placed on reverse side.) NEW INSTALLATION: (No septic'tonk or seepage pit permitted if public sewer is available within 200 fest,[ �. SEPTIC TANK Size..................... PACKAGE TREATMENT [ ] � l""" "'-'•--••'"--'".-"...._.... liquid Depth ........................... -- No. Compartments Capacity .................... Type ..................... Material...................... • Distance to nearest: Well :.."..�.............................Fdundati r t on Prop. Line •- I1' ........................... ' LEACHING LINE [ J No. of Lines --------------••••.----• Length of each line`...:4 .- Total length Depth .Filter Material ............................................ 'D• "Box ............ Type Fitter Material .................••-De p a � �Distance�t`o nearest: Well ........................ Foundation ............ Pro.._......... p rty Line ........_ .............. Depth Diameter Number ........................:... Rock Filled Yes [] No ❑ f SEEPAGE PIT [ } p ................... ..... Water Table Depth •- •---=-••- ---..Rock Size ................................. Distance to nearest: Well ------------------------- ...............Foundation ................_:.. Prop. Line ...................... E REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ------------- .................... Septic Tank (Specify Requirements) ............ ....................................._ I........•--....._................ ...----•------....---•...............•-•---••••--...._...._. ......... T w ................................................ 4 - - ------ --- - - - -- ------ -...- - (Draw existing and required addition on reverse side) { I hereby certify that i have,prepared this application and that the work will be done In accordance with San Jloogstln County Ordinances, Stats Laws, and Rules and Regulations of the San Joaquin Locali Health.District.Herne owner or liven- ' sed agents signature ceriifie's the following: "I certify that In the performanco of the work for'which this permit is issued, I shalt net employ any person in such manner ' as to become subject to Workman's Compensation laws of CaliforMa." Signed ........... ...............T ...:...... ._ ... Owner By . .. ......... .... ................................ Title ..... .........- ....................... ...................----- (If other n owner) DEP TMENT USE ONLY APPLICATION ACCEPTED BY . __. ....i. . •-•--.. DATE :� ,.:2..� BUILDING PERMIT 'ISSUED .�."........`:---.---•..::. DAT .. ................ ... ADDITIONALCOMMENTS ....---------------------r_.._....---------•-= ............................-.........................::.......... ................. . . .......... •- ------ :'......... .......................... -- --- •--- ................ ....._ ....... ..incl nDate i'.!�'�..... Final Inspection by: ..... .............................. '-- I' EH 13 24 1- SAN JOAQUIN LOCAL HEALTH DISTRICT