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MR OFFICE E: APPLICATION FOR SANITATION PERMIT - - --- -- ------------•- (Complete in Triplicate) Permit No. ..7-5 ..::.: . .....................•-- .......... -•-•------.•-•----- -------------------------------------- This Permit Expires 1 Year From Date Issued bate Issued ..,2-1.%`.:75` Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOC TI N ._...! . ?!"e....... CENSUS TRACY .......................... Owner's Name /T L • .......... one ........................ .._..--- Address ... .......... .... .......... City ............-...... .........-...__.._.. Contractor's Name --- _--------- .License # .-a-��.7�.. Phone Installation will serve: Residence 03IApartment House Commercial❑Trailer Court 0 Motel ❑Other .......................-................. Number of living units------------- Number of bedrooms -.--.-------Garbage Grinder ... ....... Lot Size ........................................... . Water Supply: Public System and name ..._ = -•-•-•------.:... Private Q. Character of soil to a depth of 3 feet: Sand❑ Silt❑ Gay ❑ Peat❑ Sandy Loam ❑ Clay Loam D Hardpan❑ Adobe"o Fill Material ...... If yes,type ............... ............ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placedon reverse side.) NEW INSTALLATION: (No septic tank or seepage,pit permitted If-public sewer i available within 200 feet,) PACKAGE TREATMENT f ] SEPTIC TANK f.],. �• �"';a. Size;..... D:C7. ........... Liquid Depth .......................... Capacity 2 00_ ---hype ............... Material. =--- No. Comportments ..f Distance to nearest: Well ....................................Foundation ...................... Prop. Line ..........I............s% LEACHING LINE [ ] No. of Lines ------------------------ Length of each line._.................... ... Total. Length ............................I' ` 'D' Box . Type Filter Material ........Depth .Filter Material Distance to nearest: Well ------------------------ Foundation ..---..--......--....... Property Line ....................... 'Ir SEEPAGE PIT [ J Depth --------------- Diameter ---------------- Number ..---:.-.....- ' -------------- Rock Filled Yea ❑ No ❑ ., Water Table Depth .................................................Rock Size --•......................•------ Distance to nearest: Well ........................................Foundation.................... Prop. Line .................. ._-- REPAIR/ADDITION(Prey. Sanitation Permit# --------- -- ------•-- Dat � Septic Tank {Specify Requirements] ...a'.- ... .._... .. . . . .. . .-....._ ..----------__-• Disposal Field (Specify Requirements) ....... . .................................................. -- - ----- . -•-•---- C11; -------------------- �... . ---------------- --------- ------ •---•----------- ------------•--•-----. ---- -------------..........---------............-.-.--------*............... (Draw existing and required addition on reverse side) I 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. Horne 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 became su ject to Work in' Co n ti Taws of California." Signed -. � - Owner By ------------------------------------ -------- ---- -------------------- ..----------- Title ---- - (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- - ------------ -.1 - .-__ ---- --- ---- DATE _,...,2..L4. .. 7S.:w: _: ... BUILDING PERMIT ISSUED ---------------- --7 ---------------•-------•---.-....----------.-.-DATE ........... .............. ADDITIONAL COMMENTS ----------- - --------------------------------------------- ----------------- -•------------------ - . ......... ..-.- • ----- --------------- ---------------- -------------------------------------------------- ------ - --- ---- �� Final Inspection Izy:`T .. ".,.._ .c��1�n`�1�..-. ... --...-Date ....�o�,. .c�. �. .......... EH 3 2!� 1-613 flev. AN OAQUIN CAL HC'ATTFF DISTRICT 8/7h 3 Y M /