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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT v .. ........................................... Permit No. (Complete in Triplicate) .......................................... / { ..........: This Permit Expires i Year From Dot*issued Date issued lc: `?� . ' � Application is hereby made to,the San Joaquin Local Health District for a permit to construct and lnsto'll the work herein ?� " describeci..Thls application is made In compliance with County Ordinance No: 549 and existing Rules and Regulations: _. JOB ADDRESS/LOCATION .2CS�F3_So. Renta $p8t1�...._TTa.Cy-..-...,�30�...�CENSUS$TRACf � F Owner's Name......... xsy...g....J...ger-]e Phone. F� . . Y-•........ Address.^ua ...iS.S?Uth...of...trallex---hous_...........City .....Tracy.................... ................... x k Contractor's Name PAI,MQUIS'I'..I?I,CJ2i$S IG-_S rRVICeFe..............License 40 .99 .......... Rhone $35!? ' Installation will serve: -0 Apartment House j] Commercial❑Trailer Court C] x Motel Other............ i u 5 cY, x , Number of living units:.-1....... Number of bedrooms .....2....Gorbage Grinder ............ Lot Size ....Acerage........ .. y' a Wo,ter Supply: Public System and name ........................................................ ...............................................Private *41 'Character of loll to a depth of 3 feet: Sand E] 'Silt❑ Clay ❑ Peat© Sandy Loam ❑ Clay t" Hardpan f3 -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 *Ido) ,NEW INSTALLATION: (No septic iank or seepage pit permitted if public sewer is available within 200 feet,} i �^ ate: R' b PACKAGE TREATMENT .( ] SEPTIC TANK( J Size........................................ liquid Depth ......... . € { Capacity .......... . . Type ........ ........ Material.... No. Compartments "A � �r Distance to nearest: :".fall ................................Foundation ..................... Prop. tine t ; x* w LEACHING LINE [.). No. of Cines ..........:........... lengih of each line.........................,.. Total'length '. ..... tm^ " 'D' Box ............ Type Filter Material ....................Depth Filter Material ................................. p Distance to nearest; Well ........................ Foundation ................. property Line ; t SEEPAGE PIT (.;) : Depth Diameter Numbbr'........... Rock Filled• Yes �] No ...... Table Depth ......................................�....!Rock Size;: ......._.�._............... z . 4. ��ES[stance• nearest: Well ::.'�F§undotionG....... Prop line s " r;s t. i rte I ........_) r W 1 .REPAIR/ADDITIONTrev. SanitationiFermit.#...... . - '.E "Septic (specify RequirentiptitsE f' _ -.:Ex.�atlu:..:..... .a' * `....�......_.... .. :'t { .... ._.. Disposal Flald lSpecify''.Requiremr�ta) ..... I g---�5••• ,..]�24 ••I�F�,de-•af�pP1'.eme�El�srg )� Ieachin drain ��-_ .13oa ........................ .......... n ...... f x .. .. rte .. .................I.............................................. ...........................................,....... ' 7 ' a AJ. (Draw existing and required addition on reverse side) k �. testily that t have prepared this application and that the work will be dopa in'`attordanp with Sara Jeeiquln �},*'��• � county Ordiriarices, State laws, and Rules and Regulations of the San Joaquin Local Health DIsMd.Herne owner er 11e>!n- fy;< sed agents signature certifies the fallowing: l "I certify that in the perf ce of•the work for which this permit Is issued, I shall not employ any person In such m6nner fr ' b as to became subject to ark an's"Compare laws of California." p Ursr 11 E cE r/ :a $i$ried ........ `�- .................... A � t ... Sf M a k (If other Tha nerl__,._ s 1; R DEPARTMFNToUSf, ONLY : �N x ?- 7� .... lf�'/.q'��.. APPLlCAT)ON ACCEPTED BY.........:................................ ......... ...... .... ... DATE t< BUILDING PERMIT ISSUED"............................................ .......... ,, DATE........ ........... r AADDITIONAL COMMENTS"............................................ ..... ............_.............................................................................. f �yy3y -. .. ........................................................................ ................................................. . fr.a ....- .................. ............... ................................. .... .... ._... .................._•.......................... . .: ..... .. i 3 .....................................................ti............................................ y F , Final Ins action b p Y: ...:.......... t p : :. -1 4 Date ' s, SAN JOAQUI L L HE L RICT r y�...,. t ' E:F!. 9 1•'68 Rev, 5M1/ <; iNyyy,l,W mn 1�