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FOR OFFICE USE: APPLICATION,FOP SANITATION PERMIT
<br /> ..........�.._.................... Permit No. 7Sf/O
<br /> _ � (Complete in Triplicate)
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<br /> '• � Date Issued
<br /> .._. ...., This Permit Expires,y Year From Date issued .�� .............
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<br /> Application is hereby mode to the San Joaquin Local Health District for a per to construct and install the work herein
<br /> described. This application is made`in'compliance with.iCounty 'Ordinance No. 549 and-existing Rules and Regulations: I
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<br /> --77 'bk.,....,. ,. 'CENSUS TRACY ...... ..I.
<br /> JOB ADDRESS/LOCATE N ..1....-.......... ....-•--- .. ..............
<br /> Owner's Name CrG G .. .. ..... '" _;.phone � ..... ..
<br /> ' itye .. C , ._. i.........................................
<br /> Addrs . r �.
<br /> Cpntractoe's Name '.. .. ::; =..Phone 1
<br /> n will serve: .. Residence W artrnenf•Hotirse ft C+lmmercial ❑Trailer Court' 0
<br /> installation '
<br /> ..... M to 0th .
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<br /> Number of living :units ar a e,.. rin er,... ,.. L�ot.Size. ;
<br /> Numlaex.of . ecrooms..., ..,G, b. a .�: .. .
<br /> Water Supply, Public System and name � ... _ ;_.. . . .. ��-:�.-'::::: ::.. 6
<br /> Private: #
<br /> Character of soil to a depth°of 3 feet:1 Sand j] Srlt(�
<br /> CIO
<br /> [] : Peat❑ Sandy Loam Clay Loam :—
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<br /> _..._ . Har'dpar; ❑` Adobe [ Fill Moteri' if';yes, type .. r rt
<br /> y- ` USt. e l laced cm,';reverse,,:side. '
<br /> {Blot ,pi,Qn,.shpwi►tg..sie...a,#..lot,..ls"g1�.ar!- o4f.. .yfem..in,. elutao.n..to'..xve�ls .,bulldings,..etc�.m la .p. .
<br /> NEW INSTALLATION: #Np septic tank or 6ep6ge art Oerrrtiitted 0 ublic sewer }s avarlable within 200 feet,]
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<br /> PACK,AGE.TREATMFNT [ ] SEPTIC TANK j ` sire.'................... �_ l "`~ Liquid Depth _._ ...... ..............
<br /> s ..,,.., ,... , -s
<br /> a E Capacity, ............ .. Type; ... .. Mdterial , No.: 6mpar#men.ts .. .. ... .
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<br /> Distance t6 nearest: Well ... ...... .Foundation Prop. Line`:
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<br /> L�ACHIN61II 9 ] No. o#' dries ... tei-g'W of eciih Brie.. ... t _.. "total Length .... .
<br /> D';'i3b ::.: :`. . . .Type Fikter M'#ite#a ::: `: Depth. Filter Miter al `. ::.i.::.:
<br /> Distance ttx nevresti Wall gF0pr I atiorr .- `"'--- 'P opertj► Lirte { _�:..':: �
<br /> S SPACE PIT_�[ ]. Depth.. ., Dipme}er.. 1 Nirrivtiter :. .-:Rock' -Fired Yes•- _No f ;
<br /> 1 Wgter,jabl ..I e.pth .,.,._;r. n-,.,cam Rook:Sire.:., �;;,ter;- ;- _;_.__.s
<br /> ;......i l , Foundc(tion ............. Pro.... l me
<br /> _,....... Well
<br /> p,�....�... .. ..........
<br /> r ; Distance to neatest
<br /> R PAIR/ADDITION{Prey. Sanitation�4rrnit.0 ... ,' .. .. aid ... ...... .... )
<br /> ;. ..k:................. .. ... s
<br /> ;Sept c Tank {Speify Requirements . .. _ ... _._ - . .�...._.;._.
<br /> eci . sT . ..... .. .. , ... . .Disposal Field IS Re s
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<br /> ..:! " :: y... . ...............................:. s i �
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<br /> ! ' Draw existi y and re urred addifron an rbverse side
<br />� hereb cern _..that I have re --area this a...--hatidtt`.._.q_.�,...... .......... ... . . ................:....�.........:.. ........_._,;.......;.. ... .. ...; .;.
<br /> t Caun ''y ce h e t "R `I"""' ri' 'Re lit bns of ifie S"n �oawiil l`a sono in atcordanea *it San Joaquin
<br /> ty 0 io c-s, S cite taws; and u e>i a d. g, i o ij+iri"ttistii''Fleibt7tti' Di'itirl t:'Heirtti� a rllti! tifY iit�bli=�
<br /> t sed 09, 9 .. . . ......_._.....-.,._.. ..................... ....... ...... ..
<br /> 9 ;si nater.,e.cer#ifi.e:�.th .following:.. -......' t ' I
<br /> rformante of the work fo'r which'this permit Is Issued,::;� ; }, ued, l shall riot employ arty porsort in such mdnnor
<br /> 1:certify that in the pe .
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<br /> da s �CoiiPatssdliisn'iaws o1FilifQ"rniq. _................
<br /> as-to Vetome sub ect tc Worktn'
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<br /> Srgned:,.......' ... . .,. '.•-�lwneir'..... .............• s
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<br /> iB ... .. _ .. ... .- -- -,Tile::r::::�,� •::::•: :::•:_�:::::: -.
<br /> (I': oth -)
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<br /> i t n owner
<br /> 'FOR: DEPARTMENT USE ONLYT '
<br />! .: .. '.'........:......:.......:..... .. _ ... .... _.. ... ... .....1......._....._...._......_..... .. ... ._ 4 .._..{..APPLICATION ACCEPTED 8Y ... . ..:., . i...... ..... . DATE . .. k�. .
<br /> BUILDING `PERMIT =ISSUED :::::
<br /> ADDITIONAL COMMENTS .. ........................ ....,. *•-• {.... .�..... -
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<br /> _ ................... ............. ......}......} ,. .. .!. .. .�. }_ .1. .d......._ .j. ....•
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<br /> F'nal Inspection Date
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<br /> SAN JOAQUIN i LOCAL (HEALTH: D15TRIG`T
<br /> r ".,.I1 94 . .�. r,. �+ 7/77 -4 b4
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