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FOR OFFICE USE: APPLICATION FOR SANITATION�`RMIT ......................... ............. '"-...... (Complete in Triplicate) Permit No. F .. I ...................... This Permit Expires 1 Year From Date Issued Date;Issued 1� nJ • Zt.�GfCE:��`�t-r4�"",,2�o i �--od}D Z/ Application-is hereby made to the San Joaquin local Health District for a ermit to constrv(tOSUS install the work herein described. This oppl' 'ion is made-.in c )lance o in nc No.44j and existvl nd Regv)�JOB ADDRESS/LOCATION . . . .... f7 f`P `:`...�� CE TRACY ... Owner's Name s .....Phone . ............................. Address :... .. .---- � ...._.�� J....._. - ------ Contractor's Name . -dq� ��.�1�. �'_ ------- License # v�1� Phon Y,......................... Installation will serve: �'' Residence'❑Apartment_House0 Commercial ❑Trailer Court 4 Motel 0 Other Number of living units:.. .��.., Number of bedrooms ..45.....Garbo a Grinder � " Garbage / .. Lot Size Q��!`L- Water Supply: Public System and name ...................... ......Privatc-& ❑ Q y o—pce X--Sandy Loam F] Clay Loam [] Character of_soil to-a depth of 3 feet:w--sand~ = silt �— Clq A 4 Hardpan ❑ Adobe [ Fill Material ,�.._.. If ves;type ••..---:- . l �s _ f {Piot-plan, showing size of lot;-Location of system in relation "to w�ells iiuildings, etcmust bb-placed on reverse side: NEWINSTALLATION: ; "= - �• I {No septic 'tank"or-seepage pit permit 6d, if publi-c sewer is,_avoilab a Wlthim,2()O feet,) - _ � PACKAGE TRE�4TMENT [']; SEPTIC�ANIC - - Size.f .I - - 41 "'�"" `--~ I q id_Depth L P a ' ` .... 4 ��. _._._....._ Zyp Capacity ./ Mdteria .:_..... No. Compartments Distance t nearest: Well :r�... S ` �:... � -foundation /.G�............. Prop. Line .e"&1�._...... /'f f ! , LEACHING LINE [ ) No. of i:Trt sXll re-* 40�4 Length of each line.. A . ._. Total Length- .. �7.................. 1 ._ f {^ 'D' Box f/� h / � Type Filter Material/��A _Dgpth Filter Mate-ial'f1 s Distance to nearest: Well . ....I..._._.. Fovndatioh .f,3_............... Property line PIT' [ j .Depth �. ....._.._. Diameter Number 5EEPAGE� ---...... ----- Rock Filled Yes ❑ `No C..- - Water TableI Depth S, - Rock Size �, Distance to nearest: Well � •. .......... .._- :..._..---Foundation ............ ..... Prop. line ---------............ t„ II ADDITION(Prev. Sanitation Permit# _ - ...- Date ------•--- } } REPAIR/, V ,� Septic Tank {Specify Requirements) r F ` .. .ham `-; - ........ I Disposal Field _(Specify Requirements) - ., / &'� --------------------- .... .................c �f........-.............._................ ---...--- -------. ----...._.._._...--- --_.......-....... ......_ ......._... (Drawd existing-an _requi red 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. 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, 1 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) i �_-t.�• �-�:_=---- --'��"�' -��-- -_� EPARTMENT USE ONLY APPLICATION ACCEPTED BY -DATE----------- BUILDING PERMIT ISSUED ........ . . ..., ..•. .. ... ...- --••-•--�._...------•- a,.w_. . kms. .:, -,:DATE--. -- - ADDITIONAL COMMENTS , ._. . � ••--• : - Final Inspection by: ..... . ........ ----------------------------------------- W--.... Date f' JOAQUIN LOCAL HEALTH DISTRICT E..H. 1 13 24 -'b8 Rev. 5M