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FOR OFFICE USE: \ APPLICATION KOR SANITATION PERMIT �ll ��................. Permit No. ..72..-If ..._...... (Complete in Triplicate) This Permit Expires 1 Year From Data Issued Date Issued .................................................. �a..:.�.� . AAcation is hereby made to the Son Joaquin Local H.dalth District for a. per 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 . , .::_ �. 1 ` -..+ ..................... .CENSUS TRACY Owner's Name ............................................. "--------................ ......Phone -----................. oo .....Lice�, _. _.... city ..............•...----•-- :_ .........Address ...... 4Za �. Contractor's Name nse # . ,�j✓� . !'hone r' .... Installation will serve: Residence ❑Apartment House C] ComirTercial Trailer Court 0 Motel ❑Other _ Number of living units:._-__ .... Number of bedrooms _.�.....Gorbage Grinder ..y--•__. Lot Size ��1� -'L ®..........-- Water Supply. Public System and name ...-•-•-• ....................----•--._._..._-......--••--------------.....----•--•----•---------------- Private,) j Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay-Loam ❑ . Hardpan'[] Adobe] Fill Material ......... If yes,type ---------------........... ---- , t (Plot plan, showing size of lot, location of system in relation to wells, buildin4s, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ SEPTIC TANK Size- + � .............•--------- Liquid Depth --- --- ..............._ Capacity/ � .___. Type_ . __ _ Material.401.0 .. No. Compartments .'.=y.._.......5 Distance to nearest: Well -_•.,/.tom .................Foundation .ZZ.*..._.___.. Prop. Line LEACHING LINE No. of Lines .... g �� Length Length of each line.__ Total D' Box . � Type Filter Material Depth Filter Materna) ` r° .............................. Distance to nearest: Well ___ Foundation Property Line 4 .................. SEEPAGE: PIT Depth -._4� f_... Diameter Number ..... ................... Rock Filled Yes a No 0' 4 Water Table Depth '. �' ' ------------ ----• ---•-----.........- ------..Rock Size .........-----------•-••-•------ � Distance to nearest: Well ...............Foundation --._... Prop. Line --1_10.7-- REPAIR/ADDITION(Prev. Sanitation Permit# ........................-............••----- Date ----------------------------------I Septic Tank (Specify Requirements) Disposal Field (Specify Requirements) .. -•-•----••----------- ................ ......................................................••--...................... ........................................_------.._........_-......................._.._..........---.....•-------•-.....__._......... (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. Home owner or licen- sed agents signature certifies the following: "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 subject to Workman's Compensation laws of California." Signed .................. ..... ------._._...... .. Owner Title - A .............................. ....... ----......._._.... (If of than owner) FOR EPARTMENT USE ONLY APPLICATION ACCEPTED BY .......... -••-• ----- .. . . ---- --•-- •..............................•-----------------_.... DATE ...��_:1.'----_--------- BUILDINGPERMIT ISSUED ------•.........................••-----•----••-•---•------......--"-----........_...........-----....---..DATE ........................................... ADDITIONALCOMMENTS ................................................:......................•---..._.... ..............----------.........................................---------- ................................__....-.•••-•-----------------•-----------••-------------••---- .................-......------....-- .................. ...................................... Final Inspection by: .. f �........... ',., �.. ------...Date ..� ..'1�- .................. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.1.3 24 1-'68 Rev. 5M - 7/72 3 M