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� nti FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 2 ........................................... (Complete inTriplicate) Permit No. ...7 .......Y This Permit Expires 'i Year From Date Issued Date Issued ... '.......... 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 County Ordinance No. 544 and existing Rules and Regulations. r _ JOB ADDRESS/LOCATIO .h .........J ,.. .. ..._ -... ........... .. ... CENSUS TRACY .... Owner's Name .. .t!hr... .........-•---••----.. ........-•--- -t...................Phone .................................... Address ................... .................................................I City ................................. ................................... Contractor's Name ELu–F-K..................... _......License # Phone .............................. Installation will serve: Residence j Apartment House o Commercial oTrailer Court 0 Motel ❑Other ...................................... r 1 Number of living units:--;:.L.__ Number of bedrooms .� i.....Gorbage Grinder ------------ Lot Size __f/0.L..4!X....t��..1`�.._---------- Water Supply: Public System and name ........................................... -- ........ Private Character of soil to a depth of 3 feet: Sand C] Silt 0 Clay ❑ Peat� {4Sandy Loam ❑ Clay Loam Hardpan❑ Adobe 'E] Fill Material ............ If yes,type ..�._._..._..._.._.._.. (Plot plan, showing size of lot, location ofsystem 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,) _ PACKAGE TREATMENT_ ( ] SEPTIC TANK[ ] Size �... .,_........_. Liquid Depth ... ............... VI Capacity .AZ20.0-- Type e/-6?62r4e 5/Material_.............._•------ No. Compartments __—c. . ._........ 1%.V r Distance to nearest: Well'..-6.2?........................Foundation .__�.__..... Prop, line ._��........ LEACHING LINE [ ] No. of Lines _..113................ Length of each line......45_0...._._..... Total Length _. .� ............. N 'D' Box ..-1...... Type Filter Material Depth Filter Material ....... ......................... . Distance to nearest: Well ........ Foundation .. r O._.......... Property Line ........................ SEEPAGE PIT [ Depth ..................... Diameter ......•_ ....... Number ............................ Rock Filled Yes d No Q 0 Water Table Depth .....:..............Rock Size ................................ Distance to nearest: Well ..•_•...................................Foundation .............. Prop. Line ...................... C ' REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .................... � Septic (Specify ts) .........................................._--- „ _--- ••----...- ---•-•--..... ........ .................................•----•...._..... w Disposal Field d eq Reeu Requirements) ... p (Specify q rnentsj ............................................................... .. n.7 ........... -•------• ----------- ............................... . (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application and th6 the work will-be donevin accordance with San Joaquin County Ordinances, State Laws, and Rules and d Regulations of-the-Son"Joaquiii Local Health District. Home owner or licew 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 subjec o orkma ' mpensation.Cows of California," Signed ....��._, ... -Owner _.... ... BY • _.............................. .............................i.. Title ......................,................................................... (!f other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY....� , 1 :.�------•-- •_........ DATE ......2, :.7. .............. .,, BUILDING PERMIT ISSUED ----------- ----------------•--•---•-.............---••-------••.... ............DATE .............•..........�......... . ADDITIONALCOMMENTS ...... ............................ a-..._............._............_... .__ :......_.__...._._... f--••.. ...... •-----•••-----•-•..................••--- -•------------.................................. ...... .................... ...._... _ _. ... ........... ................... .................... Final Inspection by: /..... .........................................Date . il.. SAN JOAQUIN LOCAL HEALrT4 DISTRICT E. H.13 241•'68 Rev. 5M 7/723 ,14