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FOR OFFICE USE, d APPLICATION FOR SANITATION PERMIT 6 � ;6 ..�-----�-�J• .......... ........................ ........ (Complete in Triplicate) Permit No. This Permit Expires 1 Year From Date issued Date Issued .........:...J.-=-• ........... .............••......_......--..., Application is hereby made to the San Joaquin local Health District for a permit to construct and install the work herein described. This application is made in compliance with Country-Ordinance No. 549,and existing Rules and Regulations: JOB ADDRESS/LOCATION:, .®®.. ��I ...............-._.......:.............. _....CENSUS TRACY ......_....._............. Owner's Name ..............Zf'��i...... - ---------------...- ...-.... .....Phone . 47.7 ........... f/ , Address ........ .!/..-�}- .......... - .. �.........._ City { f'� t Contractor's Name _------Licensee# , .. hone ..� ... .... Installation will serve: Residencel�Apartment House❑ Commercial []Trailer Court ,❑ r , Motel ❑ Other ........ ........ ----------------- !7 ` Number of living units:_...(_ Number of bedrootrt's��..��._.Garbage Grinder ..._.... . . t,.Size _,: �.. ._��,y�' ........ .___. Water Supply: Public System and name ................"---.... ----------- ----- Private C1Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ t Hardpan ❑ Adobe ❑ Fill Material .... ....... If yes'type ... ----(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,) z PACKAGE 'TREATMENT ( ] SEPTIC TANK.1 ] Size... XS------ ....... ------------- Liquid Depth ....s................ ..,��e.�, Capacity _�(UC� _..... Type .-.._..- Material..-_--_-_ No./Compar�me�iti��.v�.. ...... I ` Distance to nearest: Well ... .............................Foundatio! ....f0--...-.....3 Prop. Line . /•-•---• I Depth Filter Material F�. al Length ... •7 0. LEACHING LINE rK No. �f Lines... . ._. Len th of each line......�5..;.._. _. Totem r - g .. t D Box . .,. . ... Type Filter Material p I ... ' 4`' Distance to nearest: Well " (o sr � Rock Filled YesF~' �Na SEEPAGE PIT �Q Depth . . �-� ...----- Diameter _..__......... Number ...-. -. :r-Y- - 1__I�ater Table Depth --- .......... ----------- ---------------.. ..Rock Size I f�.:�x 3 i r i Distance to nearest: Well .----- --. _ .-.--- -----Foundation -.t`...... P 'Line _ . ....... REPAIR/ADDITION(Prev. Sanitation Permit# -------- ------- ---------JD, ate. ------------... --------------.-) l ... .. . Septic Tank (Specify Requirements) .... ....... ... . . -- ----------•---•-----•-•................ ................ Disposal } Disposal Field (Specify R quirements) ----------._ l ._ ...----.-- _-- ..----- •..._ ............. ----- ....... .. ._.._... ..--.---.... 1. . .. -• .t x t the work will-be done in accordance with San Joaquin,t ......:....... ........ .- - -------------- .----- . - . --- r (Drew existing and required addition on reverse side) '{`' 1 hereby certify that I have prepared this application and fha Co linty Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local''Healtth Dislricf. Home owner or Been= , 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 :uch'mannar I. wr as to Become subject to Workman's Compensation laws of California. P Signed ........................ Owner a BY ..----.... Title _ �.... ... ....... ........... ----.....------ (If oth han owner) f F R D PARTMENT USE�ONLY_ / `- .=----� - _ APPLICATION ACCEPTED., ...: . . ._ - ... _...... . .. DATE/./... .�9 . 21 BUILDING PERMIT ISSUED ...:........... .. ..... �``` _.....'....:...._........ DATE .......,f-----..-----_....- �. ADDITIONAL COMMENTS ----------------------- ------------•......------.....------ ................' _ .-- ------------ ._. J1. ........................................................................ ..--• ---...._--. ------...----1--. ------ ...- .............. . ..... ----------- ------ ............ ..................... . f.............. .................. _ 4, Final IAspection b : ---- ----- �,.--------- - --------------------------------- - -------• Date .,� .,/ .. SAN JOAQUIN LOCAL HEALTH DISTRICT wi c u 13 24 J_'AJQ op.. SAA 7 7 2_