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FOR OFFICE USE: r0••.. APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. ..................... __ This Permit Expires 1 Year From Date Issued Date Issued �ly. 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 comp 'once with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION . q ! 7A,,_ •.• €�� f.. . ..�......_..CENSUS TRACY -------------- - Owner's NamePhon 7Z-193 7 Address ..... .170 City _. _- ------• --- --------. 9d�•-� Contractor's Name .. �----- ---- license # 2 :3.` Phone]-- ,( Installation will serve: ResidencegApartment House-[] Commercial ❑Trailer Court ff Motel E]Other . ... .. ....................•-• ---._....--•- Number of living units.,.. . . Number of bedrooms -.4 Y'_Garbage Grinder ..... .... Lot Size / Water Supply: Public System and name . ......•_--- ..........;1;.- I --:-------•--------------------------------- ................. ------Private `] Character of soil to a depth of 3 feet: Sand ] t ! ❑ I Silt❑ Clay [] Peat❑�1 Sandy-Loom ❑ Clay loam ❑ I I C - Hardpan ❑ Adobe ❑ Fiil.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 Ipermitted if public sewer is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANK l ] Size:.,,,.............._.. ........ liquid Depth .............. Capacity .. Type .-. Material........ . ... No. Compartments _ 6- Distance to nearest: Well t _- �: ------------Foundation -------------L........ Prop. Line -------------_-___.-- LEACHING LINE '' ( I No. of Lines - , sLen9th of each line _.. .... Total Length ............................ D' BoxVN - . Type Filter,Material --------------------Depth Filter Material _-,................... ' Distance to nearest: Well ...... ------------ Foundation . ................. Property Line r SEEPAGE PIT j j Depth _. -_- Diameter .-......__...... Number ... .. .............. Rack Filled Yes ❑ No C3 O 1st Water Table Depth ---------------------Rock Size Distance to nearest:,Well ...._:._t.......... .................Foundation -........... ....... Prop. Line ..--.................. REPAIR/ADDITION(Prev. Sanitation Permit# -------- ....... .... Date ------ ----------••-----------�---) Septic Tank (Specify Requirements) ... . ..........._ .. . � r r Disposal Field (Specify Requirements) ....... .... -_.,--_.IOT)._---_ - ---- ------ ------- ............. ..... ...... .. .---- - . ... --- (Drdw existing and rse I hereby certify that i have prepay d this application and required additionwork�wiU be done.i�.--- -•-. -- ----.-..-• ------------- . ------ n accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local health District. dome owner or licen- sed agents signature certifies the following:♦ l,. I . "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." —t T— Signed . . ........... . . . ....._ -- ----- -- Owner By .- ..- - ' (I other ih caner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY , ._.........."lrtf-- ..- DATE ..✓� �.T_�. 7 ............. _.. . BUILDING PERMIT ISSUED .. ....... ......... ....- DATE ADDITIONAL COMMENTS ............... .....................---....----- ..................... ..................•----...._.. r ---' . ----•--- Final Inspection by: . _-- - ' �...---............... Date .... ..r- AN JOAQUIN LOC HEALTH DISTRICT R E. H.13 24 1-'68,Rev. 5M 7/79 a yr