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l <br /> FOR OFFICE USE: ' <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) <br /> ........:..... ..............�.�.��.......-.... Permit No. ...... .............. <br /> � 1......................................................... <br /> ..................................................... This Permit Expires,) Year From Date Issued <br /> ............... <br /> Dote Issued7 7 <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> e <br /> JOB ADDRESS/LOCATION ,... ._ k-.,... t... . . .... ...................- .................CENSUS TRACY ...........-.............. <br /> Owner's Nome ........� -x..... .......... ........ ..--Phone ................................... <br /> Address .... .f Fla.I......67..e.. .................................. City � ................................................ <br /> Contractor's Name .. G. Y!.- 1!!�.!°t..�. ...................License # c�S'�a . Phone,..,2 s?vr .� <br /> Installation will serve: ResidenceitApartment House❑ Commercial ❑Trailer Court 0 <br /> Motel ❑Other............................................ <br /> Number of living units:...i�.. Number of bedrooms . ....Garbage Grinder ..�)..,4:;:2 Lot Size ....��'c �lr.,.�..... <br /> WaterSupply: Public System and name ..........................................•...•......---•--•---..............................---...............Private <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ <br /> Hordpon Adobe❑ Fill Material .......•.... If yes,type ............................ <br /> (Plot plan, showing size of lot, location ofsystem in relation to wells, buildings, etc. must be placed on reverse side. <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK f ) Size................................................ Liquid Depth .......................... <br /> in <br /> Capacity .� �`? .. Type tZ11C.rmW7 MaterialIA :d"Nb. Compartments ...�........... <br /> Distance to nearest:y('Well .I..... ... . .. Foundation ...................... Prop. line ...................... <br /> [ ) A"x y� ...... Total Length ............... <br /> LE G LINE No. of Lines ..•..-.... Le o each line...-.. . <br /> �/�- 'D' Box .... Type Filter Material . �.!..�......:.Depth Fitter Material ...... .............................. <br /> ��Zt/Wl <br /> Distance to nearest: Well ......f��..<2 f....... Foundation . Property line <br /> SEEPAGE PIT [ j Depth .................... Diameter ................ Number ............................ Rock Filled Yes ❑ No <br /> Water Table Depth ................................................Rock Size ................................ <br /> t <br /> Distance to nearest: Well ........................................Foundation .................... Prop. Line .................. <br /> REPAIR/ADDITION(Prev. Sanitation'Permit# ............................................ Date ..................................I <br /> Septic Tank (Specify Requirements) -----•-•- .....-.--- ^.._7...•................... ........................................................ <br /> Disposal Field (Specify Requirements) ....................... .. ....... . ................................... <br /> .. <br /> -----•----•.............. ...... -_...........--.--...-. ......................... <br /> --....................-•- <br /> (Draw existing and required addition on reverse side) <br /> I 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 Runes and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "1 certify that in the performance of the work for which this permit 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 •.---`g.�� ....................................... Title .............................................-............-............. <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY . .. .. ...................._.. ............................,....................... DATE.....A.":,��.-�.7......,...._.... <br /> BUILDINGPERMIT ISSUED ................................................. .......................................................DATE ........................................... <br /> ADDITIONALCOMMENTS ................................................ ................_.............................................-............................................. <br /> Final Inspection by: ..........................................................Date ....��..7,r�:.-.� ........... <br /> SAN JO UIN LOCAL HEALTH DISTRICT <br /> E. H.13 241-'68 Rev. 5M 7/723 M <br />