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FORQFFICE USEt APPLICATION FOR SANITATION PERMIT <br /> ...:......... .r..................................... (Complete In Triplicate) Permit No. ...................../J7 <br /> ..............................................j- This Permit Expires t Year from Date Os:ued Date Issued <br /> G............................................. .... <br /> Application Is hereby made to the San Joaquin Local .lealth District for permit,to construct and install the work herein <br /> described.This application Is made In compliance wish tbunty i0rdinaha*16. 549 and existing Rules and Regulationst <br /> JOB ADDRESS/LOCATION,3Q'4. ,,il;L,.��T l .......1 .�%��. US TRACY ...................... <br /> Owner's Nome ....j.3,0&. ... :�:okR .--••----•...•.............................. .....................................fPhone ................................... <br /> Address ......30-4 A...�� l�fk ................... City ._s�T�?4���Q�4................................................... <br /> F <br /> Contractor's Name . ._ _ ���...-•- •-•--•----•--••---•.......................•--License # .at ___. Phone .fjhtz�±�':.4 . ...:..: <br /> 4 <br /> Installation will serves Residence Ig Apartment House❑ Commercial❑Trailer Court r° <br /> Motel_0_Mef ..........--•- ` -_... f <br /> p _ <br /> Number of living unitss_..__l.__ Number,of bedrooms .....Garbage Grinder Via..... Lot Size ........ <br /> Water Supply: Public System andoname ' .......:.P. .. ...- - -- .....:..... ................... `^. .........................PrivaM ' <br /> Character of soil to-'a depth of 3 feet: Sand❑ �Silf Q, •Clay ❑ :Peat❑ Sandy Loam❑ day Loam ❑ <br /> Hardpan© Ach e❑ Fill AAaterlol..........•.If yes.tyle.. ........ ............ <br /> (Plot plan, showing,size of;lot, iocatlort ciT=system In relation to wells, buildings, etc. muatfbe placed an reverse side.) <br /> NEW iNSTALLATIONs',�'(No septic tank or seepage pit permitted if:.public sewer is availableMithin 200 feet,) <br /> • , r, <br /> PACKAGE TREATMENT �{y�SEPTIC TANK( - Size...../�00........................... .`Liquid Depth ........................... <br /> 3 <br /> 1 Capacity:--AWO..... Typei&99V?,�. Material..&.&..C9(2Z� Nal Compartments _c - <br /> ................ <br /> Aa.* <br /> Distance to nearest, Well' .__�i ._•---••.......V---`_.Foundation .. ......:.... Prop. Line Aa............... . <br /> : <br /> LEACHING LINE No. of Lines -- Length of each-line... .1.0D... Total Length .. ..ftp <br /> 'D' Box IZ...... Type Filter MateriallI.KP2-. .Depth Filter Material ....Ad,................................. <br /> Distance to nearesti Well ....?Jolt`............ Foundation ...747........... .yPr' rty Line ............... <br /> t <br /> SEEPAGE PIT Depth .. �:_.----®iometer _ ...... Number ......_..... __.........Rock Filled Yes Flo Q <br /> Water Table Depth' .. ..... ............................Rock Size .1 .�.x r......._ <br /> Distance to nearest: WBII _...............Foundation • <br /> . _�.�..._...... _ � _..._. Prep lIns ../.[�......------•- <br /> r <br /> REPAIR/ADDITION{Prov. Sanitation Permit f --• ... Date : ) <br /> �:: <br /> Septic Tank (Specify Requirements! .................... :. ..............._.............-._................ <br /> r Disposal Field (Specify Requirements) ............................................. .......... . f ti 1Z.( .............__.........._..............- <br /> t ..........................................A.......... ......... f..... . ..................... <br /> W,_ .. ......... ...........:..... .....s_...................................:........ <br /> ,.;10 Y _ <br /> (Draw existing and•requlr a�fditlon on reverse 4114 <br /> ` I hereby certify that I have prepared this appiteditan and-that-the work will he dons In aciomanto with San Joaquin <br /> 'County Ordinances, State Laws. and Rules and�Regulatlens of the San JoagW 'Loeoi�Health Istrict. Home owner or lice* <br /> sed agents signature certifies the follawingt <br /> "I 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 sub(e Etat Workman" omPensation laws of%Csilifonila'� <br /> Signed ....... 4 --•--- ...... O <br /> .... ..... ... . .. _. ...-.. ..-. _ _ caner <br /> N..•'' ' <br /> By --....... .. 4 - <br /> is ..... J itl@ ........................................ ....--.... <br /> w r� - <br /> of at rpt an owner) <br /> R DE?ATTANT USE ONLY <br /> DATE <br /> APPLICATION ACCEPTED f3Y :.. . .... .. .... ... .....--- . . �.. ... ....... .,..3..�7..�:Z:l.:.............:.: <br /> BUILDING PERMIT ISSUED <br /> - ADDITIONAL COMMENTS .. . .•. ... ................. ... d_ <br /> ..--..._... �V� <br /> ... .. .....- •- .. .....--•-•................ . ........ ..Final inspection by: .- • - Date ...a.J L.`7`7-..1 L............. ............. <br /> EN 13 24 1-68 rev• 5H i SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7b 3M <br /> i <br />