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FOR OFFICE USE: __• APPLICATION ICOR SANITATION PERMIT � , Permit No. ..7.....` (Complete in Triplicate) _ Date Issued ............. This P `� ........:...._...--_-•_ err it Expires 1 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 compliance with County Ordinance No. 549 and existing Rules and Regulations. JOB ADDRESS/LOCATION .._ �) .............Wt_... . . CENSUS TRACY Owner's Na . - - - �� '"+�....................... ........ ......................._._ me�J.. ... .: ........................ ...............................Phone .............................-...... Address'-_jj .� ................ <• ............I City ......................... Contractor's Name .................License # ...............V....... Phone . Installation will serve: Residence❑Apartment House Commercial❑Trailer Court ❑ Motel ❑Other------------------------------------••------ Number of living units------------- Number of bedrooms ............Garbage Grinder ........ Lot Size ...,........ ........... ................� Water Supply: Public System and name ................:...................._----- .-----• ----.................-----Private Character of soil to a depth of 3 feet: Sand j] Silt❑ Gay ❑ Peat❑ Sandy Loam 0 Clay Loam Hardpan ❑ Adobe❑ 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.)O NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer 1s available within 200 feet,) { PACKAGE TREATMENT j ] SEPTIC TANK; ; Size---_ ---------------------------------- Liquid Depth ...,..................... Capacity -------_--------._ Type .................... Material----•---------- ...... No.No. Compartments ..:.....:............. Distance to nearest: Well ____.. .................Foundation ____._.._...._. ...... Prop. Line -----_.-_•--_:........ � LEACHING LINE [ ] No. of Lines,_z.................... Length of each line.....-.------- Total Length .........:_.....--„__......KN 1 'b' Box .......-_.._ Type Filter Material ....................Depth .Filter Material .........................:................. Distance to nearest: Well ----•............_...... Foundation ........................ Property Line ......................,. SEEPAGE PIT [ ) Depth _----------------- Diameter ................... Number ------_-------------- .... Rock Filled Yes ❑ No ❑ Water Table Depth .......... =------------------------Rock Size ............. .................. Distance to nearest: Well ......:.foundation ................... Prop. Line REPAIR/ADDITION{Prey. Sanitation Permit+#':.:::,:- ............:.:::s__.•-- ---- Date .......... :.......4............. ) Septic Tank (Specify Requirements) ......................................... ---------..........------------• ............................ .. . .... ...-- Disposal Field (Specify Rquirements) .-..-.. tr—c 0 .--- -. t---- - ...._._ ..................................................... ............... ......_. --------------•- -------------------- -................................................................................._........... - (Draw existing and'required addition on reverse side) I hereby certify that II have prepared this application 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 er licen- 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 b=ect to ark an' Compensation laws of California.” Signed -. --• Owner By ------------- .......... - --- ..-- --- . ----------- .... 3itle -------- S (If other than owner) , FOR DEPMiT ENT USE ONLY APPLICATION ACCEPTED BY -.--- ..._ _.. . DATE .. ". ._ :.._.. ------- BUILDING PERMIT ISSUED .- _.- ...... ........_.._ ...............DATE ----......................-._..........:._. ADDITIONALCOMMENTS ---------------•--- •- ••--------•----------------.....----•----•--...._..------._...-----------•---------------------------....---=----------•---•------------ ----------- -- ------------------------------------ --------------. .... •--..........._......----------------•------ --- ---------- - .. ----- ------••---- -----.._...----._._...._-. . . -- Final Inspection bY: Da#e J EH 13 2 "6 Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/71 3M L