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FOR OFFICE USE: ` APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. r/l: f6 l,3 Til - ................ .------- ............, _ _._.... This Permit Expires 1 Year From Dot*Issued Date Issued .---.'._.-.r.---• Application is hereby made to the San Joaquin Local Health District for a described. This application is made in compliance with County Ordinance No 544 and existing Rulesrmit to construct 'and andRegulations.he work rein I � J08 ADDRESS%LOCATI N .-. .S'S:."� �,L � ® eC / ... CENSUS TRACY ��-1.. ............... Owner's Name r" 4'+ � �-�..-•-. ...... Phone �/� Phone . Address ...... - I Contractor's Name --.--D�{ �. ... ..... .. ............•---:. ..---- -• �_ —`f„��/lie -•..............••---.. e..... $r•4dt� Qof _Q--.License # ................ - J -----�.. Phone I Installation will serve: Residence RK'artment HouseM`Commerc of ❑Trailer Court Motel.9.Others„�� Number of living units:.. ....... Number of bedroprns ..._ .-_-_ Garbage Grinder .. ... ... Lot Size ...... Water Supply: Public System and name ;fix �� ..Private- Character of soil to a depth of 3 feet: Sand Silt Clay t� ! ❑ y ❑ "Peat-O Sandy Loam ❑` Clay Loom ❑ Hardpan [jAdobe [:] Fill Material If yes,:. - 1. {Plot plan, showingsize of lot � � ' I+� --LL- , location of system in relation to wells, buildings;I etc. �sti.be .placed on reverse side.} NEW INSTALLATION: (No septic tank or seepage pit permitt Af public se er is vailal le within,248 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK y 1 t ] Size. - ---. Liquid Depth ................... 0� Capacity p y __ ----- Type ••--------____ Material....L.... ........- No. Compartments .....-_..Fo ndatioi) ..... Prop. Line .................•...J Distance to nearest: Well I W LEACHING LINE [ ] No. of Lines ..... Length of each line ... fTotal Length Type Filter Material D Sox ..... .... . T DepthAFilter Material ..... Distance to nearest; Wel! __-- Foundation Property Line __ _ SEEPAGE PIT [ } Depth . . .. . . .-•------ Diameter -_-- Number...... ..v*-V ............. Rock Filled Yes ❑ NoCTWater Table Depth _.._..- .._..._... .Rock ize Distance to nearest: Well .............................._-----•-Foundation _...._ Prop. Line .._.._...... ......... 11` REPAIR/ADDITION(Prev. Sanitation Permit# ____ 1 r -- ------• ----...... Date - l Septic Tank (Specify Requirementsl TJ ... Qis Deal Field ntsy ISpecify Requireme /C9Q/ - •w '`- ... .... ....... . ...........................----------- . . --- --... ...... IDrdW existing and required addition on reverse sides 1 hereby certify that I 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 Local Health District. Home owner or licen• sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to Deco eZuble. t W man's Co ens+dti awe of California.” Signed : CT/ � ' ..................... Owner By ... ... -.......... lTitle . _... (if other than owner) Z_ __ EPARTMENT USE ONLY - -APPLICATION ACCEPTED BY ......... .. ............. ........I.._ .. ...--- -_... DATE ._...GLV..-�7..y.. BUILDING PERMIT ISSUED ...........___-. •......... .... .. ....... ADDITIONAL COMMENTS .....-- .---•---- ---••--- :... .....'.DATE . ............. -- ........ --------------- ••---.- ------- ----- ---•-- ........---.. ..._.. •.......... ... •-------- -----•--•----- =- ---- . -.._..... -------------------- ----•--- .---.. ------------ -------..--- .. . Final Inspection b ` __..Date Date .. SAN JOAQUIN LOCAL HEALTH DISTRICT �F -.E. H. 13 24_Ius Rev. 5M