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y FOR OFFICE USE: 11 r APPLICATION FOR SANITATION PERMIT )Complete In Triplicate) Permit No. ........ ...... •_ 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. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .... .I-q., ..../.Y,--:..Y..ChG .: Q�?.�i:..f�. ._.._-..:...:....:.:.:.........:CENSUS TRACY ................. Owner's Name " tf,2, y /n.t ....._ o /`�� tom_ 1'!. . C..............................................................Phone ..�Y...........1.............--- Address .._,... ./�_..� .....I{lG. .Tc217. .. Q� .................. CitylJcr . l..................... -.-. Contractor's Name __ Got/'L . .'...i --- °. .5'.............. .....License # Phone ..&47.2! 0.7... Installation will serve: Residence M-1(partment House,] Commercial oTrailer Court 0 \Motel 0 Other......................................... Number of living uni#s -1...___`Number of bedrooms 2w...Garba a Grinder i g Lot Size .. ?.... ............... Water Supply: Public System and name . ......................... Private ®� Character of soll to a depth of 3 feat: Sand ] it 0 Clay j�Peat[I Sandy Loam ❑ Clay Loam 0 Hardpan Adobe 0 fill Material ............ if yes,type............... ........... x (Plot plan, showing size of lot, location of system in reiatio`n towel#s, buildings, etc;,must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 208 feet,) PACKAGE TREATMENT j ] SEPTIC TANK f ] .._. Size............................ ) Liquid Depth ,�_) �. .. Capacity.................... Type --•... Material...•--..... -•--•... rNo. Compo m ti ,..........................— ` "° rt enfa • s � Distance. to nearest: Well i Foundation i a • .........•-••--...... ............... ..:... Prop. Line ....................., LEACHING LINE [ j No. of Lines ..--------------- Length 3 of each line_......, ._�.1g-i....... ... Total Len th ............................ 'D' Box ............ Type Filter'Material ---------- Depth .Filter Material Distance to nearest: Well ..'..................... Foundation .........,.......�...... Property Line ... SEEPAGE PIT ( I Depth .................... DI meter ..._. ---------- Number ..__..__...____............ !tock Filled Yes ❑ No 0 Water Table 'Depth ........ -------------Rock Size , Distance.to nearest: Well,.......... I ..................•=......... Foundation--............ . Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit ... Date ................... • Septic Tank (Specify Requirements) ............................ ..............'. ................... ................- I r , Disposal Field (Specify Requirements) ----- '.f.�---T '----=....,(�C`� , r " ----- - ( raw existing and required addition on reverse side) �- I hereby certify that I have prepared this application_and tit at_the work will be.done In.accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health:District. Hattie owner or licen- sed agents signature certifies the following: ""_'�" "°' : x __ _ - „ , 9 9 g: "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 subject to Workman's Compensation laws of California." Signed -- -------------------------------------------- -- Owner By Yitle __. .5'_ 'Ij*?s er - ... -..._. If other than owner) . F R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE BUILDING PERMIT ISSUED ©ATE . . ADDITIONAL COMMENTS ____ . _ - ••------•--------------- .. -... .__ --•--•. -----.-.--- - ------------•--_------_._...---------- - -._.-._.-..----•-- .-_-_.- ------------------------------------ ----------/--1 ------- FinalInspection by: -- ._ ....---•........ . . . .. ... .......Date ....Zi ETI 13 2h 1-68 Ede A IN LOCAL HEALTH DISTRICT 8I7h 3M