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Le Fol; OFFICE USE: APPLICATION FOR SANITATION PERMIT r (Complete in Trlplieatel Permit No. .. .................. .........................................j This Permit Expires 1 Year From Date Issued Date Issued .............•...... Application is hereby made to the San Joaqu! Local Health District for a permit to construct and install the work herein described. This application is made 'n com is a with County O €nance No. 49 and existing Rules and Regulations: J, f JOB ADDRESS/LOCATION ..[ 11... - - J. .....CENSUS TRACY Owner's Name .......... ... ... ... .. one 4�— .5 7 Address ._. ---- ]'-- -.v�SQ � - �• '• ..__.._.P ............................ ....... 7 - -- �__ ..---•- ------...._ City - •-.-....-.-_--__--_ ------ ------ - Contractor's Name .--•---------- L--......v��--!�-- -,..License # _...............•______ Phone Installation will serve: ResidencePApartment House Commercial OTraller Court 0 Motel ❑Other .•••---••••-•---••--•---•................... Number of living units------/..... Number of bedrooms ....Garbage Grinder ............ Lot Size .............................. .4, ...... Water Supply: Public System and name ..-• •---••------------------------_.-•-•------.....-.....--•----••--..........-.......................__...Private . Character of soil to a depth of 3 feet: Sand❑ Silt o Clay ❑ Peat❑ Sandy Loam❑ Clay Loam Hardpan❑ Adobec7f F111 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.( NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK f j Size.-.•............................................ Liquid Depth ............................ Capacity -------------- _-- Type -------- --.......... Material-----___........ No. Compartments .....................� a Distance to nearest: Well ____________________________________Foundation ...................... Prop. Line .....................6 LEACHING LINE ( I No. of Lines __---------______-.____- Length of each line.-...-------_-............... Total Length ............................ 'D' Box ............ Type Filter Material ....................Depth .Filter Material ....................................... Distance to nearest: Well ........................ Foundation ..............._...... Property Line SEEPAGE PIT ( ] Depth -------------------- Diameter ................ Number --------------_----------- Rock Filled Yes ❑ No (3 � Water Table Depth ................................................Rock Size ................................ Distance to nearest: Well ________________________________________Foundation .... ............... prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ..------------------------------------ Date ---- ...__ ..................... Septic Tank {Specify Requirements) ___ !C Disposal Field (Specify Requi ement _ '. .. ----------------------- -------- --- - (Draw existing and re ired addition on.reverse side) 1 hereby certify that 1 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 tocol Health,District. Home owner or licen- sed agents signature certifies the following: "I certify that in the ormance of the ark for which this permit is issued, 1 %boll not employ any person in such manner as to bec a sub'e # o orkman's Com ensation laws of California." Signed -- BY -----------•-------------------------------------------- --•--- - ----- ------ Title (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED, BY ---------747M-- . ------- ----- BUILDINGPERMIT ISSUED ------------------------_- -••------------------•-----•--------------------------•--•----------------._._DATE ....---...----------..._...._._........._. ADDITIONAL COMMENTS ------___1 ----- - - --.-------- ._..---.---•-•----- ------•--•----------------------•- ---------------•-•-- --------------•-------....._...... --------------------------------- -------- ....................... . - - ---- ----- ---- ------- - Final Inspection 6Y ---------------------•.----..-_-._--------._--..----..-_-_._.__._......-.._....Dated 3.. ---•---- -------------- EH 13 24 1-68 ikv. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT $/7h 3M I 1