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WR OFFICE USE: APPLICATION FM SANITATION PERM l�= 7 6— ,5 /S .....,............ . . t. . . (Complete in Triplicated Permit . ..................... ... 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 In compliance with County Ordinance No. 549 and existing Rules and Regulations: ,JOB ADDRfSSAOCATION /..... ��.1��.............�1�/�...................CEIVSUS TRACY .......................... Owner's Name .......C?��E.x.............4„F .................. ... ...................................Phone .:................................ .. Address .I. . .I. 7-3 03.?.......... ,/ /LL/11 ..........3,;"...........City ......S.1G'TON, Contractor's Name •....�'.."4�T//�6=/9-L .......�r�'�z��`P�:.............License # Phone Installation will serve: Residence%Apartment House 0 Commercial❑Trailer Court 0 Motel❑Other............................................ Number of living units: ./....... Number of bedrooms ....a...Garbage Grinder ......... Lot Size CID � Water Supply: Public System and name --.•............•.............._......................... ..................................---.........Private e Character of soil to a depth of 3 feet: Sand 0 Silt Q Clay ❑ Peat❑ Sandy loam 0 Clay loam�r Hardpan 0 Adobe❑ Fill Materlol ............If yes,type............... ............ (Plot plan, showing size of lot, location of system in elation to wells, buildings, etc. must be placed an reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer Is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK size.....%:r x.tCDS..9............... Liquid Depth ....41.�5.r=....... Capacity Typo Compartmenh ....... ...... Distance to nearest: Well ......... .................Foundation ...../.Q.-........ Prop. Line ......... LEACHING ZINE No. of lines ....... ............ Length of each .`.. Total Length 1.70.......... 'Q' Box .Y ... Type Filter Materia! .a.`R_.... .�...'&epth Filter Material ............ ...................... Distance to nearest: Well ......c�—C2.!........ Foundation ........ ........ Property Line ...... 7$732.. .... SEEPAGE PIT Depth ..... Diameter -.� `. Number ...........�......... Rock Filled Yes tZ No O Water Table Depth ...... c S ' .....................Rock Size ......... .......... Distance to nearest: Well ....... ...•..................Foundation ..lO.Q.t.... Prop. Line ....`5.............. REPAIR/ADDITIQN(Prev. Sanitation Permit#_--..-. ---•----_.._....-------------------- Date Septic Tank (Specify Requirements) •..... ----".................................. ••.................................................................._................. DisposalField (Specify Requirements) .................... .............................."--".................-----.-----.......""--.....--"...._.......................... •-------------------------------------------------•-"-----•----------"---- ---------"-"------- ............._............................................................................................ (Draw existing and required addition on reverse side) I hereby--certify that i have prepared this application and that aro work will be done in accordance with San Joaquin County Ordi antes, State.Laws, and Rules and Regulations of the San Joaquin Local Hearth:District. Herne owner or Rem sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is Issued, i shall net employ any person in such manner as to become subject to orkm n's Compensation laws of California." Si ned ..<� .. ..... g ------�� <----- --- ....................... Owner BY ----- ----- - w . .... ------ M ................. Title (if other than owner) FO DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _.. = -----. DATE _.. ./.�_�`�........... BUILDING PERMIT ISSUED -""----•-- .............. DATE -.-..._.... ..<. ADDITIONALCOMMENTS ----- ------------ -•--"-......."•"--..._....._ ............................... ........................... -------- -------- ---- _....................................................... ..•._.. .............................................. ........._..".............................. ......................•--------....-------. --- .. _ Final Inspection by: .-------- .......... .......................... . ... ........•---•-•---. ...Date -- EH 13 24 1-68 Rev. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7b 3M �,�,