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+ EOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7 S:-_3 2- ............. Permit No. ........ (Complete in Triplicate) i ...................................._........----•.. Date Issued _.l•-. ". l7 7S • ....................................................... This Permit Expires ] Year From Date Issued _ _.... ... ..-_- . I Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein k described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: h _.......CENSUS TRACY .._.... ............. JOB ADDRESS/LOCATION .......... . ........... �/i�C?............. '---- .. _ r , � .dam. ,. _ -N Owner's Name ....... -C-43 ------------------- - -------- Phone Address . C;ty-__004 ��.. _...�,. � 2........ ' . . - --------'.- Commercial Trailer Court Phone Contractor"s Name ... .. ,:. 7`.U�G��,-- ;,-----. - - License #�.��.5�� Installation will serve: Residence House❑ ❑ ❑ Motel-0 Other --------=------------ -------.. Cr Number of living units:....../.... Number of -bedrooms'.-------Garbage Grinder ............ Lot Size .....�1--------------------------•....... ' Pr'rvate� Water Supply: Public System and name .-.- .............. . Character of soil to a depth of 3 feet: Sand I—] Silt❑ Gay ❑ Peat❑ Sandy Loom X Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Mdterial ------------ If yes, type --------------- --------r_. - (plot plan,i showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEIN INSTALLATION: (No septic tank or p seepage pit permitted.if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ) SEPTIC TANK ] Size------------------------__---------•.......... Liquid Depth ----- ................... Capacity ._ . ... Type -------- ----------- Material. ...... No. Compartments -----_--__- Distance ---- -- _Distance to nearest: Well . ........ .........---------....._-Foundation Prop. Line ...................... LEACHING,LINE ( ] No. of Lines ... ... .... .... Length of each line .._......_......_.....:.. Total Length ....._......_.._._. ........ IS LEACHING, 'D' Sox ..__. Type Filter Material --------------------Depth Filter Material O Distance to nearest: Well ............------....:. Foundation . .....- ..---.._...._. Property Line ........_.....,......... x Rock Filled Yes No SEEPAGE PIT [ ] Depth -'--. -... biometer ................ Number..-......._.............'-- ❑ ❑ Water Table Depth -'-------- ------ --• --------------- ------Rock Size Distance to nearest: Well ------------ ----------'----.-----------Foundation ...................- Prop. line ...................... REPAIR/ DDITION(Prey. Sanitation Permit S# .......-..- �' `'�`' Date ........................ .......... ) D _.... --.._......�i_.�.::.. c Tank [Specify Requirements) -r'' vQ-.-� ''� y ........................ ----------------3...__.................. Disposal Field (Specify Requirements) ---•--�35 ._. / .✓J? ........................ -(....... ................. ........................... --"-- ' -- ------- -------•------•-- ....--•' '---........ ------.--------- 1 - (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application'`and that the work will be done in accordance witF San Joaquin I County Ordinances, State taws, and Rules and Regulations of the'San Joaquin Local'Healih Diitrict. )lame owner or I€cen- sed agents'signature certifies the following: ) �- r , F' 7- "I certify that in the performance of the work for which this permit is .issued, I shall not employ any person in such manner as to become sub jec to rkm 's C mpensation laws of California." i' Owner Signed .:.... �.f�� ................ I Title . .... _. .. . (if other than owner) t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE ._....� _- Z.---._....--- [ BUILDING;PERMIT ISSUED .-.._.. DATE ............. ADDITIONALCOMMENTS ................ --._ ------------- -..--------------------------•-----------....... -'------.......---- ................ ' - --- - .....................................................................'•-----._.:...._-.---- ------...__.._......: __._..._...-..........._.............__........._._._....-_..R...._.....__-__....___.. .................0_..___...._.._._._ ._._. _ ------------------ Final inspection by: ..__. Date .._....1.T � '�'IS ._.--- SAN JOAQUIN„LOCAL.,HEALTH DISTRICT_ I 7/723M i e u 13 2!�z •moo o... rL � --_ - -