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FOR OFFICE USE: , APPLICATION FOR SANITATION PERMIT �� lComplete in Triplicate) Permit No. .. ................................................. F This PerniItExpires 1-Year From Dot*.lssteedDate Issued 3:x'17 . 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 County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ....7`_7.L�� '� e•................................... ......................CENSUS TRACY .......,.................. Owner's Name - 7!e?' ./ ...... ..T.....u.........11_, 7..........................................Phone Address . _ _.......... .... .......... ...... City . (.,... -. . ........ ................ ..... .. ........... Contractor's Name .....:....... ...i_ ._O-_AxvS.�.... . ...:. ..Ucense # - �� Phone Installation will serve: Residence KAportment House Commercial ❑Trailer Court fl Motel ❑Other ON Number of living units:....,.._.. Number of bedrooms _ .__..Garbage rinder .... ....... Lot Size .�� ....�....* .*...... Water Supply: Public System and name -----------•:.................:.......................' ._-�.r_._._. .._. . .. .. ...............Private ❑ Character of soil to a depth of 3 feet: .. Sand 0 Silt® Gay [J Peat Sandy Loam Clay Loam 4 Hardpan 0 Adobe Fill Material ............ If yes,type ............... ............ (Plot plan, showing size of lot, locationof system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit .permitted if public sewer is available within 200 feet,) i PACKAGE TREATMENT [ J SEPTIC TANK f }. Size------------------------------------_.__...... Liquid Depth ......................... Capacity --•----------------- Type ----------•--------- Material...................... No. Compartments ..................... Distance to nearest: Well ....................................Foundation --- ............. Prop. tine ...................... LEACHING LINE No. of lines ...--..-_:. ___.._.._.. Total Length [ ] --------�---. length of each line................. ........ ................... 'D' Box ...... Type Filter Material ....................Depth Filter Material ...-.......-----------------------------.... Distance to nearest: Well ---------------- Foundation ............. Property Line ........................ SEEPAGE.PIT [ 3 Depth ------------------_ Diameter ....------------ Number ............................ Rock Filled Yea ❑ No Q ......._W ^ Water Table. Depth,..............._:....----- ..Rock Size ............................... i f Distance to nearest: Well ......................................foundation ..................... Prop. line -----------•---------- REPAIR/ADDITIONIPrev. Sanitation. Permit# ..................................... Date ._...._._.. .................... Septic Tank JSpecifj Requirements). ........ e Disposal Field (Specify Requirements) -- --- - --- -- ►"/�- ..s------- ' --- -- ' ---�--- ... .. / :�C '--- ... ........ .... .. .. ------- 11 1 -- --------------•-- ----------------- �-----_------ ------ ............................. ............ {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 Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health_District. Nome owner or licen- ! sed agents signature I.fies the-following: I "I'certify that in the pe rmance of the work f whi this permit is issued, I shall not on to an � � p p y y.person in such manner as to bec0 sub ec or[cmon's Co ens on la s f California." 1 Signed --------- -•4 : . BY ---...- - -- —_ Title ... (If other than owner) . «:� —049-11150- TM T USE ONLY APPLICATION ACCEPTED BY -- w r= -- --------- .-..--•--. DATE ,3,-J Y. 7 -- -. - BUILDING PERMIT ISSUED __..._....'_......:.::..:. ------............ ....... .._•....___-DATE �„ . ......_...................--------. ADDITIONAL COMMENTS ...................... --- -. . ... :_ -- — ..---- ..- ....................................... final Inspection by: -----------------------....... Date ....... ._...--------- -- ----------------- EH 13 24 1`68 A-ev• 5m SAN JOAQUIN LOCAL HEALTH DISTRICT $/74 3M