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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ------- -------- --------------------------------------- i {Complete in Triplicate) --- ----- -- Date issued 14--- _-- This Permit Expires ] Year From Date 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 Count�JOrdinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION _ _ _9 �� 9 -------CENSUS TRACT _ _Z.!-•-------- Owner's Name ----- du - .�J---------C- -E0R&L ----------- --- Phone --I� -------�5 = R.knC/Shgbj___=- City ----E�R�-�------------------------------ ------ -- Address --------- -- E w__ry�Cz---------------------------------------------------- ---.License # --- :-------------- Phone ------- -------------•-------- I Contractor's Name _-.__.� ----- Installation will serve: Residence R?-Apartment House f] Commercial :❑Trailer Court I❑ Motel ❑Other - of living units:-_-- ----- Number of bedrooms _3------ GrinderY�155- Lot SizeSupply: y --------- ---------------------------------- -----------------�zlr-;-------------------------------Private p Water Su 1 Public System and name _ _ ____ _ - , Character of soil to a depth of 3 feet: Sand'❑ Silt❑ iclay ❑ Peat 5pndy Loam [� Clay loam ❑ ...... ...... Hardpan F-] Adobe,❑ Fill Material _ _ tfryes,^type ________._________________ r � - f i E (Plot plan, showing size of lot, location of system in relation to wells, bd dings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepa pit permitted if public sewer is avdi)able within 200 feet,l 11 j Liquid Depth ---7- ---•- = _ - - i-------- q p PACKAGE TREATMENT ( ] SEPTIC TANK 5i �--X 1_.___X. rw Q � - i Capacity 1 -00---- Type FIR __-_-- MatenalCl�___ 0 No. rCompartments _.__ l.1�--•-•• � istarrce-ta-nearest:-Well-----XW --------------- ---------- ------- , ---------•-- LEACHING LINE No. of Lines ------- �;?'! t� ngth of �ach line__.__�S_--------3_-- Tota! Length : -�------ ��o yrs � 'D' Bo .�� Type+'•F'ilfer..NlatECia1; _-- -------'-'-��.- -- Depth Filter Material _______I�:'--•-,-------•�------• F "I r 1 - � Pro er fLine --------------- ,Distance to nearest: Well _._- --'+t/-_ Foundation�_._.1� ---- ------- p tY ------ Dia,mete'r�-X_4.-_�•-Number _____---=G-= �------ Ro" is Filled Yes �o .� SEEPAGE PIT [ Depth ___�-�-- - - 3 � Wate Table Depth ----' --��----'---- -4------------_1------Rock Size Distance to nearest: Wli ___ Q --r------------- Foundation _ --------- Prop. Line REPAIR/ADDITION-(Prev. Sanitation-Permit# -------------------------------------------- Date --------------------••------------) r Septic.T-ank_jSpecify Requirements) ---- ---- ---------------------------------------------------------- ---------------------- --------------------- Disposal Field (Specify Requirements) ---------------------------------------------------------------------------------- ti` - - i------11------------------------ -------- --------•------------- ------------------- ____•_.__-`.�I-----------------------------------------------------------�------------------- .--__-.-----__•-----_------------------- ----------'-:+tom- _•-•----------------------------------- _� 4� -•-_ __ _ _ --------------------- r" (Draw existing and required addition on reve�se� ` certify �p application j �� `* i •I hereby cerci that I have prepared this a lication and -that_the work will be'done in accordance withSan Joaquin 9. -- _ County=Ordinances; State�Lavvsr and Rules and Regulations of�#1ielSan Joaquin L�cat Fteblth District. home owner or licen- sed agents signature certifies the following: a „ ,�, 1 "I cerci tin the pert mance of the work for whichhis`pe mit is issued, I shall not employ any persolt;in such manner as to ec m subject to rkman's Compensation laws of California:") Signed `------------------------------------------- Owner S - � . Title - -- ! -------- --------- By ------- - --------- -- -- ---------------------------------- -- ------- (If other than owners FOR DEPARTMENT USE ONLY ' i 1 APPLICATION ACCEPTED BY _.---__f___�- ---- ____.___.____-- DATE --• - - -------------- --------- BUILDING..PERMIT .ISSUED_------- ---------- --DATE__:: ____ ::�:--- ------ _7 ---_ - ADDITIONAL COMMENTS -------------- - ----------------------- -- ----=-- - ----- ---------- -- _- - t ,, _,ro � r- t_K ----------- ----------------- ------ -------------------------------------------------- ------== =--= --------= =-- -. -- --.- ----------------------------------------- � ------ ..� - -- ---- --- a - - - - ------------ = e Final Inspe -- - -• - - - - - P - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1268 Rev. 5M