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3l7 FaC�USE: APPLICATION FOR SANITATION PERMIT <br /> t_�..:.. / $. Permit No. 7._........ <br /> ;Complete in Triplicate) <br /> ........................................... <br /> This es Permit Expires t Year From DotIssued Date .-7 <br /> Issued . .' <br /> { Application is hereby made 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 County Ordinance No. SA9,and existing Rules and Regulations: I <br /> { f <br /> 6 �+ CI` ,r� .<..L!IA'! G�..CENSUS TRACY ... ..........:......... <br /> JOB ADDRESS/LOCATION LQ� .d�s�.._..4. �..... ....................P..... <br /> Owner's Name ...�P,�...... ... ............. _.............. _......_. .. ............Phone ...... .,_.:._..._...... ......... <br /> Address ......-�.�..�Q . . ,2,rn�e1.. nt�.--..� .... City _, /16t1,t .._.... <br /> Contractor's Name ? .....................................License #p ...... Phone; . '... <br /> Installation will serve: Residence❑Apartment House❑ Commercial❑Trailer Court 0 <br /> Motel ❑Other <br /> Number of living units:-.._._-___ Number of bedrooms .. ..__Garbage Grinder ....moo.. Lot Size ---.•• �'.r��-.,••••••-••-•- <br /> Water Supply: Public System and name -,........ -•-•--------....•........_...................._..............--•-•......--_:.............._........Private, <br /> Character of soil too depth of 3 feet: Sand IM Silt❑ Clay Q Peat❑ Sandy Loam 0 Clay Loam ❑ <br /> Hardpan d Adobe 0 Fill Material ............If yes,type ............... ............ <br /> (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed an reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer 4 available,within 204 feet,) <br /> -- <br /> PACKAGE TREATMENT [ ] SEPTIC TANK I Size------:-:.............•.---••••••-- •-•••-,'. Lig€d Depth .....................:.... 4J <br /> 56 <br /> Capacity .:.................. Type .. Material------:---_---..---- No. Compartments <br /> . N. <br /> Distance.to,.inearest: Well ---------_---- .................,.Foundation ............___ ...... Prop. Line ................ . <br /> LEACHING LINE [ ]. No. of Lines ---11.- .--.------ Length of each line............................ Total Length ............................ <br /> ce <br /> ...De Depth .Filter Material <br /> j 'D' Box .... Tyle F�ft Material ...... p .............. <br /> Distance to nearest: Well ............­ Foundation ..... Property Line - <br /> Y� <br /> SEEPAGE PIT [ Depth ..-_-------------- rDiameter-.:............. Number ............................ Rock Filled Yes ❑ No <br /> Water To Depth <br /> .. . .....Rock Size <br /> 1 7s <br /> Distance to nearest'We�ll --- .__.....foundation .t{.... Prop. Line <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ---_---•---••------G�. �� ` Dar .................................. <br /> Septic Tank (Specify Requirements) ........ ..... . J, !£........- -�ib!!_s ....! .:. / . ...... <br /> Disposal field (Specify Requirements) ,'` j'--------..s.......... ... ..` <br /> /6 ----- --------•--------- --- <br /> y <br /> ---------•----- <br /> (Draw existing and required,addition on reverse side) <br /> 1 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 Heallh.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 perrnit'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 ------ --- ------------ --------- ----------? Title ..... <br /> (If other than-owner <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----------ILV, - -------------- --------- DATE <br /> BUILDING PERMIT' ISSUED -----------T----------- --------------••------------------------------•----•------------ -------------.I3ATI~ <br /> ADDITIONALCOMMENTS ---------- ------------------------•..............-. -_-..-------------- .....-.-.-......------. --•..------ -=------- ................. <br /> -----------------------•-------------------------------------------- ------•----I——....... ----------- <br /> ----------------- ............---------------- -- - --- ---------....._-- -- --•-----•-------------... .... ... .................... <br /> f final Inspection by: --- ----------------------------------. _ -------Date ......cr �. .. <br /> EH 13 24 1-68 Rev. 5MI SAN JOAOUIN .LOCAL HEALTH DISTRICT 874 3M CD <br />