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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT <br /> Permit No. ... <br /> c (Complete in Triplicate) <br /> .......... <br /> .................................... ........ <br /> I— ....... <br /> .--• This Permit Expires 1 Year From Date Issued Date Issued .�d"�`•7�• <br /> Application is hereby made to the Son Joaquin Local Health District for a per to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance-No.•549-and�existing,Rules'and Regulations: <br /> t r <br /> JOB ADDRESS/LOCATIO ../..5-/. ..�--- ?.... ....-- (�V CENSERS TRACY` .......................... <br /> Owner's Name ... .........---•---•.............. :....•-•----.. .. . '".L?�1�..... <br /> Address .......................... .... .... ' .. ............. City -- --------.....................0 . <br /> 64..t�. <br /> Contractor's Name .....I...... .......... 4�'`'� License # a. � - Phot►e . ....... (. <br /> Installation will serve: Residence Apartment House 0 Commercial ❑Trailer Court 0 <br /> Motel ❑Other ............................................ <br /> Number of living units:..... .... Number of bedrooms -__.----_---Garbage Grinder ............ Lot Size ... C-. .......................... <br /> Water Supply: Public System and name --•..................................------------.•._...._..................... ..............................Private ❑ <br /> Character of soil to a depth of 3 feet: Sand❑ Slit❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay.Loom_❑. — . <br /> Hardpan Adobe Fill Material ............ If yes,type ............................ �R <br /> (Plot plan, showing size of lot, location of. system.in,relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: Q(No septic tank or seepage pit permitted if public.se%w is available within 200 feet,) <br /> ;. ; i a � —1 I I �t <br /> PACKAGE TREATMEN:fl( 'w SEPTIC TANK Size................. ':-----.,.............__-- Liquid Depth -- _-. ..........-- <br /> y .�►.�:J� _ Capacity � ... Type 1 Material. �....... No. Compartments ... -............ <br /> m -•- • -•--• , <br /> . I <br /> t <br /> `.b 0 r . ► r t Distance to nearest: We113' __. ..: �"::.-=--Foundation .......-......::..... Prop. Line ......... <br /> V. a T <br /> LEACHING LINE No. of Lines -____-3............... Length of each hne...,., .` 4......_._.... Total Length _.__� ._.......... <br /> I , , I r• <br /> 'D' Box t...✓__.. Type Filter Material',. w.-c-4.......Depth Filter Material ...._..�(�............................ <br /> I + # I e <br /> Distance to nearest: Well .---. �}--."r..__...Foundation; ._.___f..�.. ....."Property Line .... ••-•-•---.......-- <br /> SEEPAGE PIT ) Depth ....2 -------- Diameter .3 --------- Number .....� ......... Rack'kFilled Yes X No � <br /> I rLL ,, 1r vII <br /> Water Table Depth .. .....................................Rock Size .�,Y... ....�Y...------ <br /> .......Foundat€on _.� ��7-A Prop. Line ..'s r"t`' <br /> Distance to nearest: Weli ......./.ft. ................ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .....1..........-................ <br /> ) <br /> r <br /> Septic Tank (Specify Requirements) ................... ---------_- -•..............................................••--•-••---•----------- -----........ - <br /> Disposal Field (Specify Requirements) .--- --•--------- -----------------------------•---------------------•--• ................................ .......................... <br /> ----•.............................. --------------------------------•............•.........................................................-•........................................................ <br /> . <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen• <br /> sed agents signature certifies the following! <br /> "I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ............................ .......... ..... Owner <br /> By <br /> xitle ...._. <br /> ----------------. -- <br /> If other an owner) <br /> �_ y FOR.DEPARTMENT USE ONLY % <br /> APPLICATION ACCEPTED BY .../:2.. ►? e • 1 ° ' . DATE — �? <br /> . , <br /> - ..... ------ _:.._:_... ........... <br /> BUILDING PERMIT ISSUED ' - .........DATi: <br /> ADDITIONALCOMMENTS ---------•................................................!........--•--............................................ ............................. . <br /> ............................•.............................................:... -------------------; ............................................. ••-• _ ..... ....... <br /> ... _. �.... .... .. <br /> Final inspection by: ....:_ ":e ! = --•-••-----------------------------••------------....................Date _r. ......... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. u.13 24 I.-6a Rev. 5M -- __ 7/72 3 M y <br />