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FOR OFFICE v5E` I APPLICATION FOR SANITATION PERMIT / ....... ...... ..,................................. (iontptete in Triplicate) No. �/3 ...:.� ............. _ Date Issue , 7e ................ . ...I...................... This Parmit E>tplras ] Year From 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 compli nce with Co my Ordinance No. 549nd xisting Rubs and (egulgtlonse Lf'ZS +A f 4n.Li�as .fit k 6' JOB ADDRESS/I.00ATIQN � v .....................................' _ .................. .... CENSUS TRACY ..................... Owner's Name ..... jj �._ .zs 5 ...f..........°..... ......Phone .............. Address ...........1..... Sy L'CJ. .�f!`.14.ez, < ._./.r ......City ........................ ...................... .. _ .... ........ Contractor's Name ..- `� .<.... .. ........................................License # ,�� .:..Phone �+� . Installation will serve: R sl once Q Apartment House] Commercial QTrailer Gourt �) Motel Q Other 4 Number of living units:............ Number of bedrooms ...........-Garbage Grinder ............ Lot Size ............................................ Water Supply: Public System and name .•............................._........__.........._......._..........................................Private Q , Character of soil to a depth of 3 feet: Sand❑ Silt Q Clay Q Peat Q Sandy Loam Q Clay Loam Q ,. Hardpan Q Adobe Q Fill Material ............if ye:,type............... ............ �A ' (Plot plan, showing site of tot, location of system In relation to wells, buildings, etc. must be placed an reverse side.) � i . NEW INSTALLATION: ' No septic tank or seepage pit permitted if public sewer is available within 200 feet.) PACKAGE TREATMENT ] SEPTIC TANK f ] Size.........................___..............._.... Liquid Depth ................_.......� Capacity Z Type .. �'? Material...................... No. Compartments .. ...... i y Distance to nearest:.Wetl' ....Foundation .. Prop. Line LEACHING LINE [ 9 No. of Lines _... ------•----__ Length of each line..?4........._........ Total Length 1.4 ........:...... 'D' Box .. ....... Typo Filter Material ._ ..Depth th Filter Material ..._��d............................... + Property llns ' . , Distance to nearest: Well ........................ foundation ....................... ......... SEEPAGE PIT' E g Depth .................... Diameter ................ Number ............................ Rock Filled Yes 0 No ❑, E' Water Table Depth ................................................#tock Size ................................ ` Distance to nearest: Well ........................................Foundation .................... Prop. Lins ..................... REPAIR/ADDITION(Prov. Sanitation Permit# ............................................ Date ......) j SepticTank.)Specify Requirements) .......................................-- ............._.........----............................. . ........................ Disposal Field )Specify Requirements) -------•-......-----•-•-•-•---•.................................................................................:............_....--- (Draw existing and required addition an reverse side) I hereby certify that I have prepared this appiliation and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or ilcen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is Issued, I shall not employ any person In such manner as to become sub ect to a kman's omponsation laws of California." . Signed ....-f�c .. .................................. Owner ---- - itlo .. ...................................... . 1 Ilf.other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED.BY-.. .. .. -DATE _--'?X9gI BUILDINGPERMIT ISSUED ...... .................. ............................ _...............------........-............DATE .......-..-.........:.. . •-' = ADDITIONALCOMMENTS .............................................................._..........................-•---•-•----.............................I................11......... ... ..................... . --.-......... -. ........ . .. Final Inspection by: ..Date ... ..-... 13 24 148 Rov• SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3H E �;