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FOR OFFICE USE: <br /> ,, APPLICATION FOR SANITATION PERMIT <br /> _ ...... _...... <br /> (Complete in Triplicate) Permit No. .7:�... ... <br /> ......--. This Permit Expires 1 Year Fr Cate issued Date Issued .. <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 /> JOB ADDRESS%LOCATION ......... � --- .1/q f�S' /lJ............. ................. <br /> CENSUS TRACY <br /> Owner's Name .. .U..._. _.....: l�_ o... ------------------------ -------.-------....Phone - --� ► . <br /> Address ......._.. .. <br /> > City .. fl.� ../ .(J ---------­-------------- <br /> ---- -----. -. <br /> Contractor's Name ....AltFUL� . <br /> ----------­_----------- .......License #�....J��--� phone ..................... <br /> : <br /> Installation will serve: Residence 'Apartment House❑ Commercial ❑Trailer Court ❑ <br /> Motel ❑Other .................. <br /> Number of living Number of bedroom <br /> units:.. ..__... Num _ s . <br /> �..� �... _ .. _.-Garbage Grinder,..,._.:-�,--.�.-Lot Size_...�_.-------------�..._.._.... . <br /> Water Supply: Public System and name _..r5 o G-,-1�t/.-_ Private E3-' •----•-•-----.---•---_------ ••------ ..--- <br /> Character of soil to a depth of 3 feet: Sand❑ Sift❑ Clay ❑ Peat❑ Sandy Loam PE Clay Loam ❑ -� <br /> Hardpan ❑ Adobe ❑ Fill Material ........-:_. If yes, type ........... ............•... <br /> (Plot plan, showing size of lot, location of system in relation to %;ells, 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 -- ....._._. liquid Depth _.._____......_... _. <br /> [ � � ) Size.__...-- ----•-•----------�-•.�--- - ....� <br /> Capacity .. .. ._.. Type ...... ............ Material- No. Compar4kments __.-.......-. - _ - <br /> --•tea <br /> . t r <br /> Distance to nearest: Well . ...... <br /> ............• <br /> ......„-._,...Foundation ........_.._......._.. Prop. Line ........... <br /> LEACHING LINE [ ) : No. of Lines <br /> .. _.. ... _ ... Length of each line.......... ................. Total Length __........................... <br /> D' Boxes. Type Filter Material .... Depth Filter Material ...... ...,----------- <br /> Distance to nearest: Well <br /> ---------------.. Foundation ............. ........ property''Line ... <br /> SEEPAGE PIT Diameter Number ............................ Rock Filled Yes ❑ No6.3 <br /> Water{Table..Deptb ---- ___..............................Rock Size ...------------- <br /> !.------._........5 N I <br /> Distance to nearest: Well ----------------------------------------Foundation _.........,. ..._.._ Prop. line _._._...__....._._- <br /> ¢¢E <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ._............ <br /> .._ _ Date ' <br /> - ) r <br /> Septic Tank (Specify Requirements) -- . <br /> I ---..__.__._....--,-- --•-----Q--C-----------,-_•---•J---J--'-1-1--•-----------.•.....-_......_..._-..._ <br /> Disposal Field (Specify Require-me ------- . <br /> , <br /> e. - <br /> ....... .. ............. <br /> ---------- ................. ... ............;.._._._..... -. -------------- <br /> 41------- ._.. <br /> (Drdw existing and required addition on.reverse_s€de),..._ ,. <br /> I hereby certify that 1,, have prepared this application and,that the work will be done in accordance with San Joaquin <br /> County Ordinances, State laws, and Rules and Regvlations.of'the San Joaquin-Local,-Health-District. Nome owner or licen- <br /> sed agents signature certifies <br /> I certify that in the performance--oUthe work for which this permit is issued, I-shall not employ�r person in such man er <br /> as to became subi to W-rkman' ompens�ition laws of California." <br /> : r <br /> w. <br /> g � Owner t <br /> i ned . _ <br /> 10 <br /> (If other than owner) �. ...rt a ,. , v,.., ,. .. _ Y._ .<�,_ ,!. .r <br /> __� _ FOR DEPARTMENT cUSE ONLY i <br /> APPLICATfON ACCEPTED BYDATE_._ ._ . ...... <br /> BUILLDING PERMIT ISSUED ... .-_ <br /> ............ <br /> .DATE --.--------------------- ...... <br /> ADDITIONAL COMMENTS .............................. <br /> :._._... a_ ----------------------•-----. --------- ........................ <br /> ..:.._.:----_ •-- -------------- •-�--_------------------,.---••--.-�_:.... <br /> Final Inspection by:Nit I Date —�o � , <br /> r SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> cu1324 , _A _ p <br />