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FOR-,OFFICE USE: APPLICATION FOR SANITATION PERMIT 75 Permit Wa. ..................... .................. ............................. (Complete in Triplicate) ........ ........ti................... Date Issued . .. 7 This Permit Expires 1 Year From Date Issued Application is hereby mode to the San Joaquin Local Health District for a permit to construct and install the work herein Regulations- described, This application is made in compli ce with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIO � ..... .. -"" ---_---------- ........CENSUS TRACY ..............••-•-......_ 1,J... .._{.., .__ ---.Phone ...................:.. Owner's Name _......... ...._.. . . .._.......... Address City ' . License #a,,� .7177. Phone - Contractor's Name -• -- �-- "" Installation will serve: Residence Apartment House❑ Commercial []Trailer Court ❑ i Motel ❑Other .-- ---- . --•------------------ ------ . �- Number of living units:..._. . Number of b rooms .. .__...-_Garbag G inderlot Size -. ".. ... Water Supply: Public System and name ... - ...---....Private [I Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Fill Material _..... . .,_ If yes,type ......I----• (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer/is�available within 200 feet,) !. SEPTIC TANK' Size.. - �/� --- Liquid Depth .._ ---•---•••-•-•- PACKAGE TREATMENT [ ] � " " Capacity� G`�". . �nype - Material.. No. Compartments -:.......... VV Distance to nearest: Well Foundation ...- / �.."_ Prop. Line ......... LEACHING LINE ro No. of Lines "_.. Length of each line .....��__......... .Tatal Length _. p'................ _ th Filter Material ..-`.. . 'D' Box ... _. Type Filter Material _� _ __DeP Distance to nearest: Well .44c,4 Foundation 1�--�--- Property Line -. ------••• ��_.._ Diameter ! . . Number Rock f=illed Yes No ❑ SEEPAGE PIT [ Depth _..... �..... . ` r Water Table Depth ..._�� ------------------•------ Rock Site ......... — r Distance to nearest: Well _. ': -- -- • --Foundation _,. A . "...... Prop. Line .._. -----.--...- REPAIR/ADDITION(Prev. Sanitation Permit# ------- ------ E Date ---------------------------------- Septic Tank (Specify Requirements) ... r Disposal Field (Specify Require ents) oe r --...------ �. {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 Son 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 become subject to Workman's Compensation laws of California." Signed •-------------- Owner ........... -•---- Title (if other than owner) FOR DEPARTMENT USE ONLY��- = —._ - l� . ._. DATE �.5 ........ . ............................ ------ .... . �---------- ... •---•- .--- ----.- -- " ADDITIONAL COMMENTS .. ...._._ ............................. ---------------- --".....--".. -.=... .- ...._. -----Date -- _ ... . . Final Inspection b SAN JOAQUIN LOCAL HEALTH DISTRICT .,; - 7/72 3 LK