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FOR OFFICE USE: FOR OFFICE USE: - APPLICATION FOR SANITATION PERMIT p ............. --------- ..... ..-- . Permit No.7./.Pf (Complete in Triplicate) . ........................... Date lssued.o�._�--�This Permit Expires 1 Year From 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. 549 and existing,Rules and Regulations: 5362 "Gtt Street, Banta, .._.CA. 953a�-F_..- ........CENSUS TRACT----.....•- --- .... JOB ADDRESS/LOCATION .................. -- Leeli.e J & Ilene Freitas ...__----------------------- 209`835-281 ..... Owner's Name...... Phone Address....... ------------------- P . 0.p....Box 7165 - :_ .� _ City --....._ .Tracy. .... �... .ZiP:_: 9537 . . Contractor's Name.. Owner ' --License #--------- ---- Phone_...- _5-28-- .. ....... f Installation will{serve: Residence ❑ Apartment House ❑ Commercial & Trailer Court ❑ r Motel __. € s E] .Other- ------------- ..... ---- i { x 100 Number of living units:................Number of bedrooms..... ....Garbage Grinder........----Lot Size.--.-- �.......... ----,{---... . Water Supply: Public System and name_--.............. ....--- --------- Private [ , Character of soil!to a depth of Sfeet: Sand ❑ Silt ❑ Clay ❑ Peat ❑ Sandy Loam 0 Clay Loam [X Hardpan ❑ Adobe❑ Fill Material.. .._ ___If yes, type-------------------------------- i (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,) PACKAGE TREATMENT [ ] SEPTIC TANK [ .] Size._ Liquid (depth.h...'---------------------- 1200 Gal ' Capacity..., Type Mat�rial_...f'`817ie31 ------ -•-No.Compartments.. 50 f eet I:...._Foundation....-_Cement ..Prop. Line.t �0 Feet" Distance to 6earest: Well. ............................ R Onei ' Total Len th ..0' x t - �. LEACHING LINE ( ] No. of Lines......................:......Length of each liN5.--.._....._•- ---.:. g , 'D' BoxCemeri pe Filter Material.,_...Rock---.Depth Filter Material, -.. 2_.. 'ee t :------ ............ i Distance to nearest: Well----------- -----------_ . Foundation-----------------------------Property Line...------' ....... SEEPAGE PIT [ ] Depth-.. _ ........'Diameter............_.---..Number---- ----------- --------------- Rock Filled Yes E] No E]' Water Table Depth............. Size..... -- ---- Distance to nearest: Well--------60 Feel; Foundation....._.-. ___ .......... Prop. Line.l.1.0-__Fe t..-_ I { 1 REPAIR/ADDITION-(Prev. Sanitation Permit#_,--. --•- -...- ---.. .._...._- Date - ] i t � , Septic Tank[Specify Requirements]_........ ._ :--- - --------- ... ............ ----------- Disposal Field (Specify..Requirements) ----- - --- ---- ------ .. --- F ---•--•--•-------------- ................................ -. ---------------- .............. 4 - { :.:.. . ........... ---- ----------------------- ---- --- (Draw existing and required addition on reverse side) i I hereby'ertify-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 Local. Health District. Home owner or.licensed agents signature certifies the following: "I certify that performance of the work for which this permit is issued, I shall not employ any person in -such manner as to become�ujct km s Corpe sation laws of California." Signed.-_. ----.--Owner i Title.......:: ......... .... (If other than owner) t FORyDEPARTMENf-USE ONLY ---... APPLICATION ACCEPTED BY....- . DATE - .- __------- DIVISION OF LAND NUMBER __.......:....... ................... . �._._ _. ._�_.� ------ :_ ADDITIONAL. COMMENTS.-<:.:... ......:...................... _ k ., --- - �.. --- . ._ -- ----- --------------- --------- --------- --------- -----I ---- - ------------............... .:.-_..... Final Inspection bY--------....- ---- F/.... Date. REV 7/76 3M EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fes s1 a7