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W- 10, "Im geA.�� FOR OFFICE USE: .................. APPLICATION FOR SANITATION PERMIT ....................... . (Cemplefe in Triplicate) wr This Permit Expires i Yew From Dato Isswd Dah Issued . ..... Application Is hereby made to the San Joaquin Local Health District for a permit to construct and inrtall #w wait hanin described. This application is made in compliance with County Ordinance No. sig and existing Rules and Regulations. JOB ADDRESS I a� �os �L... .. .. . .. .............. . _...CETVSItS TRACT ...... �7Owner's Name _.. I Phone C Address . . . ©�?D vii. - . .: I..... ty . i r,. Contractor's Nome ........ ....License# Contractor's .��3. Phots :....... i . .... . .. .. .... .. .. ....�. Installation will serve: Residence Aportm*M Hou ❑ Commercial j�frailw Court Motel❑Other......�2Z-ft.�t.'t.'i..�...�. Number of living units:............ Number of bedrooms ............Garbage Grinder ............ Lot Size -r`.. Water Supply, Public System and name .. Private _...................._....... :_. Character of soil to a depth of 3 feet: Sand❑ Silt[:3Clay ❑ Peat❑ Sandy Loom C3 Clay Loom)� Hardpan❑ Adobe❑ FIII Mcteriol ............if yes,tYP0 , 3 (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on revenM side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT O SEPTIC TANK{ ) Size................................................ Liquid.Depth .... .. ci . T Material...................... No. Compartments Co s5 x Pa ty ................... Type .................... - .,`• Distance to nearest: Well .............. .Foundation...................... Prop, Line........ T LEACHING LINE No. of Lines ......................... Length of each line .................... ..... Total length '6' Box ...... ..... T Filter Material .Depth Filter Material., YPe ..... . Distance to nearest: Weil'..... .. .............. Foundation ........................ Property Line f SEEPAGE PIT ( J Depth . Diameter Number Yes ❑ No ! Rock Filled Water Table Depth ......... ......................................Rock Size .................... J Distance to nearest: Well ............ ..............Foundation Prop. Line REPAIR/ADD!", 114(Prov. Sanitation Permit,F ............................................ Date ..................................I Septic Tank (Specify Requirements) .............................. ...........`.. .................................................. li `s Di oI Field (Specify Requirements) J I ......... ( raw existing and required addition on reverse side) i I hereby certify that I have prepared this application and )bat the work will be done in ast*nlance whir Seat.Jeettieitt ' gulations of the San Joaquin local Health District. Hem*owner w County Ordinances, State Laws, and Rules and Re District. Ileew- rr` sed agents signature rertifies the following: ' ' p P eY y Person t "I certify ,fiat in the performance of the work for which this permit is issued, ! shall net of"play an In strsh tstattsee► r.; as to become subject to Workman's Compensation laws of California." Signed ....... w e O nor ....... . Jitle . _ .0 By Z. If other i owner) FOR DEPARTMENT USE ONLY A ( APPLICATION ACCEPTED BY . .il' » �'ws !..••••..• wn..... ......... ....... ... ............. DATE r1.,�. ., ! BUILDING PERMIT ISSUED ..... .... ...... ......... ........................................... ............ ....... . .DATE ..... "j ADDITIONAL COMMENTS ..... "' _ . . .............................................._.......... ...... ............................................................. .... .. ... . ... .................. .... ............................ . ,�...Jr^ � ....... ........Date c' ... .... �.................. .:. ?-rYr„�x�'.................... .....:........................ ........ ... ........ Final Inspection by: ..//� � Eii 13 2h 1-6tI ftcv. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M f 1