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FOR OFFICE USE: APPLICATION FOR SANITATION PEOMIT ...................................................... . 05 (Complete in Triplicate) Permit No: ... .......�.-._-.. ............ ..................... This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District fora permit to construct and -install-the work herein described �T �i apii tion 's mode in complime with County Ordinance'No: 544 and existing Rules and Regulations:I' -�.o�-- eve JOB ADDRFSS/LOCATION .:.W'.,,side of +ktiii, apex. 450' North of 4th. __--,.._...CENSUS TRACY ---------------- •-,_ Jimmie W�.nchell . OwnersName ............................. ....••... .--••--• --...•-• -••----• ----•- --.....,-...------------ .... ..... .........Phone ................ Address 383.5..E►._Main.................:. City' ' '------------------Mock.t;Ein.....:.:._...._.......................... Contractor's Name -.Roto Rooter.. Sewer Ser. License # 2'71539 ... Phone 4652b1b F .............5=.................._.........._.._.........._.- ...... Installation will serve: Residence ®Apartment House-E] Commercial []Trailer Court " Motel ❑Other .......... Number of living units....... Number of bedrooms _...._•...Garbage Grinder --- Lot Size ................ } 3 I Valif. Water Ser. Water Supply: Public System and name ......................................._................._.:....._._..........................................Private ❑ Character`of soil to a depth of 3 feet: Sand r] Silt❑ Clay ❑ Peat Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobes❑ Fill Material no......-. If yes, type .-.-. (Plot plan, showing size of lot, location .of. system in relation to wells, buildings, etc. must be placed on reverse side.) V\ NEW INSTALLATION: (No septic tank.or seepage pit permitted if,public sewer is available within 200 feet,) t PACKAGE TREATMENT [ ] SEPTIC TANK Size.`....A..m....5..X_.9...................... Liquid Depth ....G-k'.......:........ V) 1200 _ Precast . Concrete 2 � Capacity Type .... No. Compartments _..::.... T e Material.-----••--•-••-• ..................... Distance to nearest: Well n a 10, 5' ...............................-Foundation ........................ Prop. Line ..:---.......:......., Q LEACHING LINE [x] No. of Lines ....2.-------------. Length of'each line-------0.t..85 ...... Total Length 1701.................. 1 D, i3ox yes..... Type Filter Material ....rock.......Depth Fester Material .....]$"........................ --------- 1 Distance to nearest: Well .ztLa.--=-•-•_-:_ _ Foundotionl .."-..-.. Property Line 5.' �0 --------•-- ------ •-- -•-•..-- 1 j f � .----- Diameter :_.._-..•-...... Number .. ....:.-•---�� -�..._..Rock Filledzry-Yes No F E AGGE P—IT f DOergii 2 , CG W a epth /a Rock Size , .1 .- #xgXgDistance,to�nearest: Well .....n...........................................Foundation 10' . Prop line ...................... REPAIR/ADDITION(Prev. Sanitation Permit#\....----•--------------------•------------- Date ..............._.................. ) ;Septic Tank (Specify Requirements) -------------------- ••---- -------------------•--......... -- --------------- !Disposal Field (Specify Requirements) ..------ .:............................................... ................-.-.......................................................... •--•--•----- ----------------------------- ................-------------------------------------------------------------------------------- ------------------------.................. -----------------------------------------------------. ... .... ... ...__..-.......----------.._....----------------------------------.......................................... 4{Draw existing and required addition on reverse side) I hereby certify that I have prepared this application dnd that the work will be done in accordance with Son Joaquin County Ordinances, State Laws,-arty Rules and Regulations of the San Joaquin Local Health District. Mom* owner or [icon. sed agents signature certifies the'following- . "I certify that in the perforrnanwoi. the work for which this permit is issued, I shall not employ any person In such manner as to become s biect to Workman srCompensation laws of California." Signed . .: ......... _._..`....... .. .. Owner. �" `-� l ; Contractor By ....... =-..'.....:..... ...-•--••••-- .. . title .`. ........:. f o her than owner)',. * Z, • FOR DEPARTMENT USE ONLY, f - APPLICATIO ACCEPTED BY`... DATE .._-`. ; = ... .. BUILDING P MIT ISSUED .............. ........DATE ............................................ ADDITIONAL-COMMENTS N............. _- i y........--•--......... ......... ------------------------------------------------.......:........... ._:.. _.....--.... .. .... . .......................... . ....... ► Final In by: .._._ - ci .. ............................ D . .............. . _ -'.VN JOAQUIN L L HEALTH DISTRICT' 13 24 F_ H- 1. 6R fav- 5M• •�. .. / � ... �"- 7172 3 .til