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wa rVK Urril-t LOSE: APPLICATION FOR SANITATION PERMIT ..................................... .w_, Permit No.-72,-..��.L (Complete in Triplicate .................. ........ ...... ...... This Permit Expires I Y"�r From Date Issued Date Issued .....-0 ........... ......... ........... Application Is hereby made to the Son Joaquin Local Health bistrict for a permit to construct and Install the work herein described. This.,application Is made In compliance with County!Ordinance No. 549 and existing Rules and Regulationst 'JOB ADDRESS/{OC 4L AD 6V'-#�-- ?-.'57-tENSUS, TRACY ......-........... ... 14N ... .. ........9.. .. .... ...... Owner's Name ---------------------------1-......... ........... Address -.12-40-4 City ........................ ............... ........... . .,4;:w Contractor's Name ----- tv - .........License Phone installation will serve: Residence 0 Apartment House 0 Commercial ATraller Court 0 0 Motel 0 O/sa �o7�GUbr1JG t5 herein � Number of living units:... Number ofbedrooms -X,2U..:Garbage'.Grinder .4)4..:. Lot Size �Nciter Supply: Public System and name .Silt . ................... ......... ................ ............. yLrivateCharacter of soil toa depth of 3 feet: Sand'A% z Silt[] Clay,< PeatO Sandy Loam 0 Clam 0 Hardpan E] Adobe C] 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 p;!mitted If public sewer is available within 200 feet,( PACKAGE TREATMENT SEPTIC TANK %A ....................... Liquid Depth ......................... Capacity- -- ------ --------- Type ..............''---- Material..!..............:... No. Corn partmelits .......... "Distance to nearest: Well ------ ---------...................FoLindorlon .............--------- Prop. Line .......... ...... LEACHING LINE No. of Lines ........................ Length of each line....-i.._._-_............I Total Length ........ ............. V,Box ..........- Type Filter Material 4...................Depth-.........Dep!h Filter Material ............. ... C . . .......................... Distance to nearest: Well .............. .... Foundation ........................ Property Line ..e........:........... SEEPAGE PIT Depth .................... Diameter ................ Number .......... Rock Filled Yes 0"'No Water Table Depth............................. ..................Rock Size ....................:....... Distance to nearest: Well ... ......... I .i ------- ..........Foundation .................... Prop. Line ........... ........ REPAIR/ADDITIONIPrev. Sonitatio I I n Permit# -..........................! Date ----............................j V-, Septic Tank (Specify Requirements).... ..7... 11�.....I-Sep4h-k- ;2 '40 I ...ajIM 7- Disposal Field (Specify Requirements) j�... ---Ii., 49.s� ........... ...... Q-------- . .................... ......... ........ ........... ..............................................------------ ..................... . ................. ...............-!..... ....... ............... (Drawaxistingaind required addition on-reverse sidel ........ I hereby certify that I have prepared this application and that theo v;cirk'.will be done In accordance with Son Jamiluln County Ordinances, State Laws, and Rules and Regulations of.the Son Joaquin Local Health District. Heine owner or licen• 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 suble;to Work man.s C amp ation laws of California.-, Sign Owner A By':-: ..... ..... AA.95� ............... .............. Title ----- ..?................. ............................ . other than owner) tT FOR DEPARTMENT USE LY APPLICATION ACCEPTED BY .__..../ 2-- . .... ----------- "I- - 77 --- --- BUILDING PERMIT ISSUED . ...... DATE... �, 7------------ .............DATg .�...... -------------------------------- ADD TIONAL COMMENTS -- - ------- .............?I- ...........r /3- ........... ........ .......... Final Inspection by: ...-.... 7 ..�ro-. ................. ------ Eh 13 24 1-68 adv. !>m JOAQUIN LOCAL HEALTH DISTRICT I �7 ..................... SAN /7h 3M