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FOR OFF CE USE: <br /> APPLICATION FOR SANITATION, PERMIT <br /> .... Permit No. <br /> (Complete In Triplicate) <br /> _'... _, . ..� r <br /> __._..... ...........----....-----._............._..... - Date .-77 <br /> This Permit Expires 1 Year From Date loomed <br /> Application is hereby made to the-Son Joaquin local Health District for a permit to construct and install the work herein <br /> described. This application is made in co ce with County-Oedinonce No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION D.wit.. .._ ................. ..... <br /> CENSUS TRACY' .......................... <br /> Owner's Name .............. .d7 .. _........ <br /> ----------------------- <br /> .... .. . W <br /> Address . _ ...... .... <br /> . <br /> City �"+4+-�.- 3/7 <br /> �� <br /> Contractor's Name license 91t � 3 u3. Phone '` W "�6�/ <br /> installation will serve: 3 Resid.encen(Apartment Housefl Commercial❑Troller Court I] <br /> Number Motel ❑Other ............................................. <br /> r of living units:...... _.... Number of bedrooms ..;-'—.Garbage - - � ,�� � . � <br /> Garbe a Grinder . .•--- Lot Ze ... .... ..... ..........f.. ._..... <br /> Water Supply: Public System and name ----------------------•_ ......... .......�....._._.........Private ❑ <br /> Character of soil to a depth of 3 feet: Sand❑. Silt 0 Clay ❑. Peat❑ Sandy Loam❑ Clay loam <br /> Hardpan ❑ Adobe 4 Fill Material ............ If yes,type............... ............ <br /> (Plot plan, showing size of lot, location of system in relation to-wells, buildings, etc.-must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit :permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT .[ ]' SEPTIC-TANK j } Size..................................I............. Liquid Depth....................... <br /> --- --- <br /> Capacity ----------- --- Type --------------_.-- Material................... No. Compartments ...................... <br /> Distance to nearest: Well -----....--•........................Foundation ...................... Prop. Line ...................... <br /> LEACHING LINE [ No. of Lines ..---- --- length of each line............................ Total length <br /> 'D' Box -Type Filter Material ....................Depth .Filter Material .............._............................. <br /> Distance to nearest: Well ........................ Foundation .......... ............. Property Line ........................� <br /> SEEPAGE PIT ( ] Depth ----------- Diameter ._.........___. Number .....................:...... Rock Filled Yes ❑ No C <br /> .�.��,.. <br /> Water Table Depth ..............-.......-..........................Rock Size ........... •-•----._..:.. <br /> }� Distance to,nearest: Well ---------------- -_----...._..........Foundation ..................... Prop. Line ............. ........ <br /> ' <br /> 100PAIR/ADDITION(Prev. SanitatioWPermit ............ .......:..... Date _.._........................... -) <br /> Septic Tank {Specify Requirements) --...... t-------­------------------- --------- ..... ....... ._ ............. <br /> Disposal F' ld (Specify Requirement s) -------• ..._ _...._:' -- -.-- <br /> -------------------_---- ---- ------------•--------- ......._... ---------------------------- --•-------.---•- ......---------------- _._. ...--.--.............. <br /> (Draw existing and required addition on reverse side) <br /> ------ -- -- ----- ----------•::- --..._... -----......... <br /> � a <br /> I hereby certify that 1 have prepared,this application and that.the work wlll_be do e16—accordance .with .San Joagnln <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health:District. Home owner or liven- <br /> sed agents signature certifies the f6ilowing: " - -- <br /> I "I certify that in the pe rmance of the work for"Which this permit is issued, f .shelf not employ any person in.such manner <br /> as to become ublect orkm;7:C pons tion laws of California:" <br /> Signed _e <br /> ,A.7 <br /> --------------­---------- -- <br /> .. . .. .... ............. tavroer <br /> . <br /> I BY --------------------------------------- ..------ <br /> ---- --. ••------ -- -- -----.._ ...-•----- Title __ .. ..... ..----------_...-.........--------_._...--.--- <br /> (If other than owner). ' <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY DATE _ .." s �.7- <br /> • <br /> BUILDING "PERMIT ISSUED --- -•-----'•................... ................................ •---- ........ DATE _ <br /> 11.5 . .. <br /> ADDITIONAL COMMENTS 11-5 <br /> .............. ................ ....._.......................:...... ........ <br /> - ... f .! o.w. <br /> ----------------------•- <br /> .. �.__....-.. <br /> Final Inspection by: _ ------- .....Date°..... .......jam/--.- <br />'' EH 1.3 2h 1-683 Rev. 5M <br /> SAN JOAQUIN LOCAL IiI"AI.TH DISTRICT 8/74 3M <br />