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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .7 7 ) /-y y. . . .. t✓n I Yw�ntplete In Trlpitcotel Permit No. ... ... .......:............................................... � - ............ ........................................... U �l This Permit Eyxplres ] Year From Date Data hwed�.`/�,7,7issued ' 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 ADDRESSAOCATION ...... ......CENSUS TRACY .......................... Owners Name .... ..... .. ... ..................Phone .................................... Address lIV ..... ....1 ..l......2.0-..................City .. �F- .�;� . Contractor's Name . ..................... ......................License # . . ' � .. Phone . ... Installation will servo esidence WApartment House❑ Commercial❑Troller Court Motel Q Other............................................ Number of living units:............ Number of J3edroorns .......Garbage Grinder ............ Lot Size ...................................... . Water Supply: Public System and name . °.P td .��..............................._......._..........................................Private Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy loam p day Loam Q p Hardpan❑ Adobe Q Fill Moteriol yes,typed (Piot 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 300 feet,► PACKAGE TREATMENT ( ] SEPTIC TANK Size ......................................... Liquid Depth ..........................' !kw Capacity 1;�fiP.. ps ..61g*" Material...................... No. Compartments ...�.......... Z Distance to nearest: Well ....................................Foundation J.-O............... Prop. Line .................... � LEACHING LINE [ ] No. of Lines ........................ Length of each line............................. Total Length .........................V 1 'D' Box J........ Type Filter Material ... .. -- ...Depth Filter Material ..../............................. • , Distance to nearest: Well ........................ Foundation ........................ Property Line ................ . SEEPAGE PIT [ j Depth .................... Diameter ................ Number ............................ Rock Filled Yes ❑ No r10 Water Table Depth --..............................................Rock Size ................................ Distance to nearest: Well ....it..................................Foundation .................... Prop. Lire ..................... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ we ..................................) SepticTank (Specify Requirements) ............................................... .............................. ........................... Disposal Field (Specify Requirements) ................................................................. ...................................................•-•---...................---....----.....................--•--...........................--•--........................................................ (Draw existing and required addition on reverse side) I hereby certify that t have prepared this application and that the work will be done M accordance VAA San J0001011e County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District.Herne owner er Been, 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 termer as to beco a subject to orkman' Compensation laws of California." Signed .. Owner By ............... .. ............ .. ........................................_......... Sitle --- ............................................................... IN other than owner) FOR RMMTMENTRSE ONLY APPLICATION ACCEPTED BY ... .................... DATE ..(�....:`.:. . BUILDINGPERMIT ISSUED .................... . ..................................................................................DATE ....................................... ADDITIONAL COMMENTS .................................................................................................................................... .................................................. ................................................. Final Inspersion by: ............... .........---.......Date ..:.....,.. 4L -- Yr.......... EH 13 24 1-60 Rev. 53M4 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7,h 31