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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit Na. .:.�.. -•.-.. .�..�..._.. ........... 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 alicotion is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: 5' 35 rj� b ,rvC-y JOB ADDRESS/LOCATION RCN „ [F.�. - -- --- - .._...... . ... �CENSUS TRACY .......:.................. Owner's Name .�.14�z...... ... ....... ............... ...........................Phone ........... ........................ Address p `� _ .0.4 �...... ...... �F._......... Contractor's Name --- QC-- License # ....... Phone Installation will serve: Residence'oApartment House Commercial ❑Trailer Court a Motel ❑Other ___ _ ------------------------ Number ----------- --. --- -Number of living units:_ - ._ Number of bedrooms.3......Garbage Grinder . _. _ Lot Size ........ . ... .. ...E:............_. vt Water Supply: Public System and name _. ......... - - ...................Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay 'Peat[❑ Sandy Loam ❑ Clay Loom ❑ Hardpan ❑ Adobes Fill Material ... ._ If yes,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 TANKn ize. ... . ... -.. _-...-....._..'. Liquid Depth ....., 'n ...___.. Capacity F P QD- Type�`'esR -� Material.�..;c.�. ..- No. Compartments .....Z........."� Distance to nearest: Well/ �'_. .................Foundation ._ls`�..... Prop. Line ,._._. -5 LEACHING LINE No. of Lines00 r Length of each line 91S _. Total Length ...7.-0.. ........ 'D' Box T Filter Material _._ -.. . Depth Filter Material ...-l.P�..._......................... YID < t P Distance to nearest: Well}0 ------------ Foundation v .A_.-. Property Line ....._.7.r®.T SEEPAGE PIT Depth �...�� .- Diameter �.... Number `.._._. Roc Filled Yes [( No C Water Table Depth ...19.0_, -"_-------------_-------- Rock Size Distance to nearest: Well ........................Foundation __/V 0.` Prop. Line .... _.._... REPAIR/ADDITION(Prev. Sanitation Permit# ... ... _._ . ---_ Date _.__--..._.......................) 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 occordance with San Joagwor 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, 1 shall not employ any person In such manner as to become subjec o Workman's Compensation laws of California." Signed . . � .> +4 f .13. ..dam._. a..o ......I�.� Owner t1e /� ' BY . - .. —Tt (If other tha owner) OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYG- _ DATE . . 2�......." 7�- - .. BUILDING PERMIT ISSUED . . _ _._ _..- .. ..... .DATE . ADDITIONAL COMMENTS ..... .. _ -......... -- ----------------- .......... ...•.............. . ._... -. .._. _.....f. . ... _. ..._ .. . . Final Inspection by: ... _.. .... _..._... Date ..7f�� ............ . .... SAN JOAQUIN CAL HEALTH DISTRICT J r E. H.13 24 1-'68 Rev. 5M _7172.3 M