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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No-7—....... <br /> ................................................... This Permit Expires +I Year From Date IssuedDate Issued ._6. ��_.-73 <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> .r <br /> JOB ADDRESS/LOCATION .............127.._S.choah*. ..............._ CENSUS TRACY <br /> ._........ <br /> Owners Nome - ' - . .. _ .... ...... <br /> ���Y---B�x��•et-t..._......-•--•---•--•---••.................•-•---...... _......_Phone �'�$�OzFLF�F <br /> ..............:.......•---• --- <br /> Address ..._....?__.'7... soma _ }..'^ <br /> .............I..._......_. ..._.... city <br /> ontrattor's Name ._.._..H1 cJ�arc '.s_- api ..Tas3k......................tLic�n e # --- b 8•} -] --... Phone ...1;. - <br /> Installation will serve: Residence f]Apartment House] Comm6reial oTrailer Court 0 � $ <br /> .1 1 <br /> I Motel 0 Other ........................... ..... <br /> - --------- <br /> Number of living units...-------- Number of bedrooms -.'.�.;L_-Garbage Gri der ------------ Lot Size .._. fl'.x100•!..1/1 <br /> ..... <br /> Water Supply: Public System and name .................. ... <br /> G lfir......__.... .....................................Private <br /> Character of soil to a depth of 3 feet: Sand 0 Silt C:]�4 Clay [] Peat❑ Sandy Loam 0 Clay Loam 0 <br /> I i< <br /> Hardpan 0 Adobet KI Fill M;4011,11 --------- If yes, type ..................... <br /> (Plot plan, showing size of lot, location of system in relation to wells,196ildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pitS.ermitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK, y� <br /> ] Size- ---------------------- --- liquid Depth .......................... <br /> Capacity -------------------- Type.--:--,;....... Material...................... No. Compartments <br /> Distance to nearest: Well ( 1 "-i5n .... — �r <br /> ...._�__._._.,-•---••-------•--•-•--Foundation ---------------------- Plop. Line <br /> LEACHING LINE �*•' t ' <br /> ( ] Na. of Lines ..-•-----.1-•-•-------- Length of each line._...__4Q.'__----•-..... Total Length ...._.?�:4._'...._..•-__-•-. <br /> 'D' Box 1--------- Type Filter ateria 2.".....Depth filter .Material <br /> Distance to nearest: Well II <br /> Foundation ..._ _2fl.'_....._ :''Property Line !!a'......... <br /> SEEPAGE PIT [ Depth _25'..--------- Diameter !......33--._ Number _.._.___ a <br /> '� .._-.1_...... Rock 4Fitled Yes ® No C3 <br /> Water Table Depth .....111­1*40. __..Rock.Sd=e <br /> Distance to nearest.. Well _... .Foundation ' <br /> ....�.,...,.....�.r..- ---- ... ...... Prop. Line ......IQ_'........ <br /> . <br /> REPAIR/ADDITION(Prev. Sanitation Per,it# ......... ---------------------------------- ) <br /> - � --•--- Date --•--•--•-----•-•--•-•-------• - <br /> Septic'Tank (Specify Requirements) -_, ............... •-- ....................... <br /> Disposal Field (Specify Requirementsl -.••-.--40' Leach Line <br /> ._ --_.- - -------- <br /> I 8\ _ Pit._33"•X2 .'.. <br /> ............................ <br /> r.-..._.__. .... <br /> --------------- ............... ...... <br /> ----- --------------•--------------....--•• ••-•................................... <br /> -••-- ....__... _.... __.._ ..1t:_... -------------- <br /> _ . - <br /> -------- ........'.................. ............ ....... <br /> (Draw existingand required addition on rever a side) <br /> I hereby certify that I have prepared this application and that the work will a done in accordance with San Joaquin <br /> County Ordinances, State laws, and Rules and Regulations of the San Joaquin Local Health District. Horne owner or licen- <br /> sed agents signature certifies the followin1 g: <br /> "I certify that in the performance of the work for which this permit is issued I shall not em to an <br /> as to become subject to Workman's Compensation laws of-Cillfo`rnia. p r Y person in such manner <br /> Signed ........... .................................... <br /> -- --•---••-----•----••-•--••- ---......-•----- Owner <br /> • - ................. title ............CD21.t_xaC.tD.r.......__.......,....__..._..--•--- <br /> (If other than owner) <br /> r _ FOR PARTMENT USE ONLY ` <br /> APPLICATION ACCEPTED BY ...... . .._ _ . .. <br /> ................................----...................................... DATE ...(:-_�.�.---~�---��............ <br /> . <br /> BUILDING PERMIT ISSUE........ <br /> DATE <br /> ADDITIONAL COMMENTS <br /> ......._._.... <br /> ............ -•----. .........................Inspection by: . _._ - • .................. <br /> .............. <br /> ... <br /> ...................... <br /> ...................... <br /> ...........ate............ <br /> - <br /> • --•----•--• -• • .... 6 <br /> -.., ._ 01 SA JOAQUIN 'LOCAL HEALTH DISTRICT <br /> E. H.1-3 241-'68 Rev. 5M 7/717 'A .v <br />