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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT permit No. ._�s. _..... (Complete in Triplicate) f Date Issued .................I....... .+�............... This Permit Expires 1 Year From Date Issued and install the work herein ode to the San Joaquin Local Health District for a permit to construct Application pp lien n is herebymThis application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: dost C ..cs-•�- CENSUS TRACY •....-----•-. l - JOB ADDRESS/LOCATION ..... 7. ... _.Phone .......................... Owner's Name r ...... ......-----•-•-......-----•-- City _ -�i-- Address �y,_r 7-- Phone Li . l ... ... cense i ..--1�./-�l l Contractor's Name r#ment HouseCommercial OTrailef Court 0 Installation will serve: Residence Apa ❑ Motel E]Other ........ :_...-. t ` _ Garbage Grinder "�- lot Size .��•�•� -••-- } Number of living units:....,.- Number of be ooms . - -• private ❑ ( Public System and name .. - .... Water Supply. Peat Sandy loam ❑ Clay Loam ❑ Character of soil to a depth Silt Clay ❑ ❑ th of 3 feet: Sand ❑ Fill Material ..._:.._.-. if yes,type ......................... Hardpan ❑ Adobex' — ---='- - � laced on reverse side.) buildings, etc: must be p (Plot plan, showing size of lot, location of system i rermtted°#wells, sewer is'available within 200 feet,) NEW INSTALLATION: (No septic tank or seepage p' P ff.�. Liquid Depth 47-"..........•..... � SEPTIC TANK Size.... .--- PACKAGE TREATMENT l ] No; Compartments -•• Capacity` GC�.(j l��yPe aterial..: � �+- r T Pro Line .-- ......... S � . Foundation ...tom-....__.... P• � Distance to nearest: Well } - �, Total Length ..�fsr�...•.........-- I No. of Lines a-- -••...:. -. Length of each line._-.. rr LEACHING LINE J�fj .................. ... Type Filter Material fG ......Depth Filter Material -... • 'D' Sox .._�.... Typ r Distance to nearest: Well -. Foundation ....C_. .-.=- property Line - - r Rock Flied Yes No ❑G __ Number �• - _ Diameter ---••-•- ...... ......... SEEP PIT Depth - � r k �' ......_..Rock Size ...... -•--•---r----:-•-..... ? Water Table Depth _-.- -- _Foundation - F_- ......... Prop. Line .-A................ Distance to nearest: Well ' --- Date ---------- ---•---�--=---..---•--•� REPAIR/ADDITION(Prov. Sanitation Permit -------.---• 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 ion vin I County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Na4l1h District. Nome ownee or )item sed agents signature certifies the following: !e any p { certify that in the performance in such manner " of the work for which this permit is issued, I shall net 00111101 y as to become subject to Workman's Compensation laws of California." 2 Signed .:..&1-1-if der ..... .............. .. Owner 3itle . .... ay - t than owner) FOR DEPARTMENT USE ONLY -- --___Y IC .s— -- - - DATE ... . APPLICATION ACCEPTED BY . ..-_: ... , _ .. - DATE.- .......... BUILDING PERMIT ISSUED . ..... .. ......:..... ..............._ ._. . .�..--- -. ------------------------ ---------- ADDITIONAL COMMENTS - •-- Gf C'"�� ---- �." f;.. ........ ..... ..• . ......... ....._.............-. .............. --------- ---- -•.............. . ................ } - -.... . ...Date ' Fina! Inspection by: .. •- �� ' �� E SAN.JOAQUIN LOCA L,HEALTH. DISTRICT 7/72 3 LK 1