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FOR OFFICE Uses APPLICATION FOR SANITATION PERMIT ........I............................ . (Complete In Triplicate) Permit No. % r.✓S.a.. .......1>.:................................':........'�. .. -• oDate ......................................................., This Permit Expires I Year From Issued Date issued Application is hereby made to the San Joaquin Local Health District for a permit to tonstnict and install the work herein described. This application Is made In compliance with County Ordinance No. 549 and existing Rules and Regulationsr ...............................CENSUS TRACY ........ ............:: .JOB ADDRESS/LOCATION .. � ... ._ .. .... •• .... Owner's Name ........ . /U�1 ��:�^-.. ................................................. ._.............Phone ..................................... •� 17. %- 1 _. _. . . ::....:..'.._..Ci ' Addreaa .... a� v�p ! M .. ............. f ,. r t.. Contractor's l�Ia�ne'_--...= � ---.._...�. .::..�. . `�`.�L. .�'-•�License=�' �.��:�� -.. Phone"'p:""":'�.................... f Installation will serve: Residence❑Apartment House Commercial❑Traller Court ❑ Motel ❑Other......-=----•-- ..... .. Number of living units------------- Number of bedrooms Garbage Grinder ............ Lot Size -- � 1 Water Supply: Public'System and name . ........................ ... -------.-.-...._......._.i.. ....._.._.._.... .................._Private[� . Character of sail to a depth of 3 feet: Sand Slit Clay Peat Sandy Loam C! Loam p ❑ . ❑ y ❑ ❑ dy � �v ❑ - Hardpan❑ Adobe Q Fill Material ............If yes,type............... ............ )Piot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed an reverse side.) NEW INSTALLATION: (No septic tank or seepage.'pit permitted If public sewer is available within 200 feet,J PACKAGE TREATMENT [ 1, SEPTIC TANK# ) Size......................... --•................... Liquid Depth ........_.. .............. t Capacity -------------------- Type ................. Material...................... No. Compartments ................:.... „Distance to nearest: Well ................... ...... Prop. Line ..... .....---•-•-••...._. LEACHING LINE [ No.-of Lines ------------------------ Length of each line............................. Total Length ............................ `D' Box -------..... Type Filter Material ....................Depth Filter Material .---------............. ...................... At Distance to nearest: Well ........................ Foundation ........................ Property Llne ...................•... SEEPAGE_... [ I Depth ------------•------- Diameter ................ Number ............................ Rock Filled Yes ❑ No Qp Water Table Depth ........_._. .....---•-•----•...............:....Rock Size ................................49 ' a Distance ro nearest: Well ........................................Foundation :.......--•--•-...,_ Prop. Line -.........-....�.:.-.� 41 REPAIR/ADDITION IPrev. Sanitation Permit# ............................................ Date ...................................1 4 SepticTank (Specify Requirements) ........... ....................................*.................................... ..... ....... . ........w_................. Disposal Field (Specify Requirements) - x' �j•-��"•- �tsl._. ..- -1J...... ... ................. 3�- ................ ................... ........................�... . ._. ..............---------............ ..........._..........................- ............................................................................................................-............................................................................................ (Draw existing and required addition on reverse tide) 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. Horse owner or [icon- 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 become subject to Workman's Compensation laws of California." Signed ------------ •.............. . ...... .................. Owner By ................... .... .. �..-- -- Title .................... ...:.. .. ..... -�- -�- (I# other than owner) . . , FOR DEPARTMENT USE ONLY ; APPLICATION ACCEPTED BY ........... ... DATE..-... .. ... .,�......... BUILDING PERMIT ISSUED .....................:................................... DATE -.......... '...�� ADDITIONALCOMMENTS ---••--------------------------- ------------------•- -•----..............------•----•----•--..........---......---...._.-------- ...................... ..-•..........................................................................•-............-......--•----•----........-, ............................................i .---...-•...................................•--..-!_.....................--.....-_......... -----.....................---.........,.,............................................ .................................... .• ;. Final Inspection by .............. •--- -------------- - .........Date .. ..�5..... EH 13 24 1-68 Re's. _qf SAN JOAQUIN LOCAL HEALTH DISTRICT S/?h 3M