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FOR OFFICE USE: -�- APPLICATION FOR SANITATION PERMIT ......................I......................_ (Complete in Triplicate! Permit No. � -.. ...... ' •----.- s This Permit Expires>< Year From Doh Issued Date Application is hereby mode the San Joaquin Local Health District for•a permit to construct and Install the work herein described. This appiicotion Is made in compliance with County Ordinance No. 549 and existing Rules and Regulations, ' JOB ADDOSS/LOCATION ...� sso !... c .:15 for 1(o,of Alf? T / �� yy sides rf� .......................................,�'........CENSI.IS TRACY Pl ..............I.................... . Owner's Name ....... ............................................... .............................phone 1931`-�...`!� 7 Address ............ ... ..o ...__ .. ....... City Contractor's Name ....W�'r! •.., _. license# l '. 'g�... Phono '`IA/� -'-. -�- Soiy................. ... ..........._... Installation will serve: Residence Q Apartment Wouse[- Commercial o'raller Court ] - Motel ]Other_. 9a L 14......H ,-ie Number of living units:.... ...... Number of bedrooms .. -..._Garbage Grinder .-:__ Lot Size r/y/yG Water Supply: Public System and name ...........i.............. :�. +- ................... ..._...... -•-. Private -------• i ate� Character of soil tq a depth of 3 feet: Sand Q Silt Q Clay-0. Sandy loam 0 Clay Loom a l ..e Hardpan QAdobL-S..FIII laterlat ....`If Yom.type.................... (F'(ot plan, showing size of lot, location of *system in relation for wells, buildings, etc, must be placed ori reverse side.) i NEIN INSTA"TION: (No septic tbnk or-seepage pit permitted If public sewer is available within 200 feet,) PACKAGE TREATMENT ( SEPTIC TANK; ] Size................................................ Liquid Depth .................... ...... -- Capacity JAO!?.C.y/Type&! _A�r Material..._ ' G..... No. Compartments . Distance to nearest; Wel7. l ._. ....:.---�A�.............•---....Foundation .gip.-- ...... Prop.Line f.Y...._._.......-_., ��:....... LEACHING LINE [ ] No. of lines ......... .:......... Length of each hna.*..:: ----.._....._.. . Total ,tength-�Jg............... . V Box ....1...... Type Filter Material ..A�&..._.Depth Filter Material °T o Distance to nearest. Well .......yG ........... Foundation ;...../ ............. Pro Line. �Y..it /.._... SEEPAGE AIT [ 1 Depth .._... Diameter �� r ' Q � I Number ...:....................... Rock Filled Yes No Water-Table-Depth ................................................Rock Slze ........... - :_..._........... ,... � Distance to nearest Well .......foundation Prop. Lino ......._............... R1PAlR/ADDITION Prev. Sanitation Permit# Date ' ; - SepticTank (Specify Requirements) .............. -....-.-......._..........._...........................................--•-•.......................:_._:...............: ' Disposal field (Specify Requirements) ............. . '-._...._......_................. . .._i...._....._.. .................-----------... --------------.....--------.._....._......._...................... ..._........_._..._._._... :... ..-- { _.......'. " ...................................... . i (Draw existing and required 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 Laced Health District.Horne owner or Mn ea - sed agents signature certifies the following: ` . "I certify Haat in the performance of the work for which this permit is issued, i Shall not employ anyL person In such manner as .to become subject to Workman's Compensation laws of California.,, {t Signed ------F• .� 97!Y.�..f .................................. Ownen. . By ............... (If.other er) I` RL DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .. .............I.....................--...__.. DATE..., _.s f ., ,....___..... BUILDING PERMIT ISSUED ..".._......._..... ................... DATE .._...-•----........_...._._........ ...... ................... ADDITIONAL COMMENTS .................__..........................................:..........,.......................................................... .............................................................. ..........................................................................................._....................................... k ...........................................i- -r-.::..._..:.....:::...y�_........... ..incl.__ sp................by. ...... ... ......... .....L . .... _......._..................... __ SFinal inspection by: ..-.. - Date -"•-•- ER �3 2 �-6 v' SAN JOAQUIN LOCAL HEALTH DISTRICT $/?h 3?04