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�5.`-fir��r7�.1� Y�1:7i� —--.--��+-•�,.e-.�.��...,� -q-�. ,.�,.-r; <br /> ...... .................................... . APPLICATION ICOR SANITATION PERMIT ooff� ` <br /> ...... .......................................... #Compute In Triplicate.) Pemeit No. ./...Lffn' <br /> ... This Permit Expires 1 Year Frere Do#*Issued Dane issued .�...............G , <br /> Application is here6Y made to the San Joaquin Local Health District for o permit to construct and Install the work herein <br /> described. This application Is made In compliance with County Ordinance No. 549 and existing Rules and Regulations, <br /> JOB ADDRESS <br /> /ICKATION ,.. .5 . .. ...................� .. .......... .�!�?-. .,......CEiVSUS TRACY ........ .... .... <br /> Owner': Name ': J <br /> .Phone <br /> Address -Z ...... -- .................. Ci ... _ ................ ... <br /> Contractor's Name ... :. ._......... ...........•---.......License ...................... Phone1 <br /> Installation will serum Residence aAportment House Commercial 017raller Court 0 <br /> Motel❑Other ........................................... <br /> Number of living units:_........... Number of bedrooms //' Garbage Grinder <br /> k Water Supply= Public System and name ................................--•- . ........_.....__....---..._.�Bina ............_.... �....A-f�- R <br /> ... <br /> Character of soil too depth of 3 feet: Sand❑ Silt❑ C1ay Q` Peat❑ Sandy loam ❑ day Loam ❑ - <br /> Hordpan❑ Adobe 0 Fill Material............if yes,type ............... ............ <br /> r (Plot plan, showing size of tat, location of system In relation to wells, buildings, etc. must be placed an reverse slde.j O <br /> { <br /> NEW INSTALLATIONr (No septic tank or seepage pit permitted if public sewer Is available within 200 feet,( <br /> PACKAGE TREATMENT [ ] . SEPTIC TANK j, Size................................................ Liquid Depth <br /> Capacity ./. Type If-.1 ;� Material................... . No. Compartments....... <br /> �------• <br /> Distance to nearest: Well ��� . Prop. Line.:.---------......_... <br /> LEACHING LINE t f <br /> [ ] No. of Lines . .................. length of each fine.....................•._.... Total length 0. ............. <br /> t <br /> ' I <br /> 'D' Box .. ......... Type Filter Material _� :...Depth Filter Materia! .. ...................•-----......... <br /> Distance to nearest: Well ......................... Foundation ........................ Property Line ................ .. <br /> SEEPAGE PIT [ ] Depth Diameter ................ Number ......... .................. Rock Filled Yet ❑ Na <br /> Water Table Depth ------------------------ __-Rack Size.__.._.- -- ...................... , <br /> Distance to nearest: Wel! ----......--•...........................Foundation ..................... Prop. line ........._.......... <br /> REPAIR/ADDITION(Prov. Sanitation Permit# .............................. -- Date ..................................I <br /> Septic Tank (Specify Requirements) ......................................... ..._................._..---.................................Y............_... <br /> Disposal Field (Specify Requirement&) ...................................................................................................... <br /> .._....._.:...............:.... <br /> .. 1 <br /> -•................••----......__.......-••••-••-----•-- ••--.........-----•.............-•----......_....---....-•--•----...............__....................,--•--.............................. .,.:... <br /> ................•.•-•-----....---....-----.........--•---------••-----•---...-----................_....---.........-----............._........:...-•-------......---......_.......----.........._......... <br /> (Draw existing and required addition on reverse side) I <br /> I hereby certify that I have prepared this application and that the work will be done In accordance with Sats jeaquiee <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or hien• <br /> sed agents signature certifies'the following: <br /> "I certify that in the performance of the work for which this permit is Issued, 1 shall not employ any person in such mannei <br /> v as to become subject to Workman's ompensation laws of California." <br /> rSigned .......... °...' �-'..... ... ................................................ Owner <br /> By ............................... <br /> ..........:......:.;------- <br /> ......-.... - Witte <br /> • If other than owner <br /> . ---- •--•--........- .....--.....-_............................. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ... ...... DATE .. .,.., :. Z..... ... -: <br /> BUILDINGPERMIT ISSUED ..:............. ....................................... •-----..I............ ......DATE .............._......--------.............. <br /> ADDITIONAL COMMENTS .......................... G <br /> . <br /> ........................................................ ------.......... .1 ................................................................................................. a <br /> . : . ... . . ............. ........ . <br /> i a nsp.e.c..io. n... .y......... . ...- . ....•--- <br /> ....Date ... <br /> ........ <br /> EH 13av• . — <br /> ... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />