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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> J ......._..: .. <br /> � <br /> (Complete in Triplicate) <br /> Permit NO."...7�' ..`f:3 <br /> . ./.. :fib <br /> ................. ...... _:....... Date issued.............. This Permit Expires ! Year from Date issued - <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work here:n`l <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regu.lotionss <br /> 6 <br /> a <br /> JOB ADDRESS/LOCATION ......� �/r .:. .....lO,/� #2?#0.........J� ........CENSUS TRACY ........... ............. <br /> 001 <br /> Owner's Name ........ ��ee l .....� .%/ . . <br /> j/``"� .Phone .............. <br /> Address ... City ,.6�t 15..-. 5� �.:: <br /> Contractor's Name .. "� - <br /> /► <br /> C -efe-7-f--"r-� . : '� :. .:.....License # " f ..; Phone --*W45 . <br /> Installation will serve: Residence j Apartment House 0 Commercial QTroller Court <br /> Motel Other.. <br /> Number of living-units:_.---.... Number of bedroomsZ: =-Garbage Grinder ............ Lot Size ... +�h'/ e.,. ....... <br /> Water Supply; Public System and name '. ..... . ......................................................................Private 0 a <br /> Character of soil to a depth of 3 feet: Sana i]. Silt[3 Clay E] Peat Q Sandy Loam o Clay loam Q ' <br /> Hardpan o Adobe Fill Materlal ` ........If yes,type.... ...... .. ........ <br /> - .' - .. , Aa aaammrA�araarararrc.r.Yr .. <br /> (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.s� <br /> NEW INSTALLATION: (No septic tank or seepage pitpermitted-if-public-sewer is available within 200 feet,( U. <br /> PACKAGE TREATMENT. ( J SEPTIC TANK I I Size ..........4577X.4v.` ...... Liquid Depth fi <br /> capacityType -� Material ... ... ! 1No. Compartments .... ....... <br /> Distance to nearest Well :dtr ..: ......Foundation /.0..:........ Prop. Line ......g <br />_ �LEACHING LINE [ j No. of Lines ... Length; of, each line..." ... r................... Total .Length ...........................et <br /> ._ <br /> 'D' Box Type ,Filter Material. ,.::.. .........Depth F:Filter Material <br /> Distance to nearest; Well....::. .. Foundation Property Line ............ <br /> SEEPAGE AIT [ j Depth •....... l?tarnetei" ' ....:...:. Number <br /> ......... .: Rock Filled, Yes Q No 0 <br /> s j Water Table Depth ...... ' ..•--- .... .....Rock Size :#. <br /> �i ... .. <br /> Distance to nearest: Well ........ ...................° :...Foundatian Prop. Line <br /> REPAIR/ADDITION.(Prev. Sanitation Permit# Date ) <br /> Septic Tank (Specify .Requirements) ..................... :...•. ... .... .......... ............ <br /> Dispo l Field (Specify Requirements( ......0.... - . <br /> ... <br /> j (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 Rules and Regulations of the San Joaquin Local Heal&District. !ionto owner or Item. <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, l shall not employ any person In such manner <br /> as to beta ublect to Wark an' Compensation caws of California." <br /> Signed - i ........... ...... Owner <br /> By ----------- ----------- -- ..... Title -.-1i ...... ......... <br /> (If of er than owner! <br /> _ FOR DEPARTMENT USE ONLY x <br /> APPLICATION ACCEPTED BY .... / <br /> .. ..... DATE . .;-... <br /> BUILDING PERMIT" ISSUED .::........................ - DATE _.. -------- <br /> ADDITIONAL COMMENTS ------•. ................. - :-......... .. <br /> --• --------..._... _ .......... ....... <br /> Final Inspection by: ... .......Date .. ... .... . ........ <br /> EH <br /> 13 24 1-6f3 li'ev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />