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` FOR OfFICE USE: ; APPLICATION FOR SANITATION PERMIT Permit No. 4 �9 lComplets in Triplicate) This Permit Expires 1 Year from Date Issued Date Issued ./................ 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 incompliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOC TION .._.. .� ...... .......CENSUS TRACY' ..............:........... Owner' Name3—..................................:............. ......Phone ................................_.__ Addre ............. -• --•-• �..............................City � ........ ................_.._... ....._._. Contractor's Name ..---• r .................License + af. .r. Phone installation will serve: Residence : rtment Houses] Commercial❑Traller Court 0 Motel 0 Other.............................................. {dumber of living units--------- Number of be ,......Garbage Grinder �...... Lot Size ..��Qyr��.......... Water Supply: Public System and Warne ___--- -----• w .......��-, .. .....................................Private ❑ Character of soil to a depth of 3 feet: Sand❑ Slit r] Clay Peat❑ Sandy Loam 0 Clay Loam ❑ Hardpan Ij Adobe fk fill Material ............ if yea type............... ............ (Plot plan, showing size of lot, location of 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) PACKAGE TREATMENT [ ] SEPTIC TANK I j Size......:......................................... Liquid Depth ...................... Capacity -------------------- Type ------ ............. Material...................... No. Comportments ...................... Distance.to nearest: We11''...:............._..............Foundation _._.._................ Prop. Line .....................t i w t.! , LEACHING LINE [ j ' No. of Lines ------------•_.......... length of each line---------------------------- Total Length --.........._._........._ .i 'D' {lox ............ Type Filter Material ......I.............Qep#h Filter Material ............................................ Distance to nearest: Well ................:....... Foundation ........................ Property Line 0 SEEPAGE PIT [ j Depth ------ ------------- Diameter ..............._. Number ..._...__... ............... Rock Filled Yes ❑ Noor Water Table Depth ....Rock Size Distance to nearest: Well Foundation Prop. Line g R EPAIR/ADDITION I Prev. Sanitotion Permits _ Date ................:. 1 - Septic Tank (Specify Requirements) ..........:.......... ----- ...-•--•-• J ....... -----................. Disposal Field (Specify Requirements) .......... ....• ...... — l �. .. ----- ----------- -------------.................----------- ............................ ---------•---•-----•--------•-•------- (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 Son Joaquin County Ordinances, State Laws, and Rules and Regulations of. the San Joaquin Local Health:Dlstrlct. Horne owner or Ikon- sed agents signature certifies the following: i "I certify that in the performance of the work far 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 caner --- ---- - v. By ----------------- ...... __.. ..= •----••........ Title __..__. (I ther than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- -- ----- -------------------- --- - DATE . -/-- ----�-- .•ISSUED --•-----------•--._....-- BUILDING PERMIT ©ATE ADDITIONAL COMMENTS ....................... .. . ----------•-- ...... -•. .................. ........................ -------..------------------------------------...... .........•---....................................... final Inspection by: .................... ------ ..__......__.. --------------- ate ..... -. _ ..... / � ,EH 13 24 1"68 Rev. 5M SAN JOAQUUIN/LOCAL HEALTH DISTRICT, $/7a 3M Cb I