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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �� 967 Permit No- ---------------- i............................_------- ------------•-- (Complete in Triplicate) ? --------------- Date Issued .f :y.�..--Y This Permit Expires 1 Year From Dates t to construct a sued Application is hereby made to the San Joaquin Local Health District for a per ' nd install the work herein described: This application is made in compliance with County Ordinance No. 549 and existing Ru L les and Regulctt+orfs: ;�. 2 _. .. ; CENSUS TRACY ....,. 9� JOB ADDRESS/LOCATION -- . �'� � � - ...� - ---------------------------- v a .a. _ P Owner's Name ._- d.. YC�-►�..... .: � . �� _-'. - .._. hone ( Pte._!- City ........... ...:..... Address Z- '�,l�- P� ..-----• ---------- Contracto �P�� --- ---- - -- ._..License ..:... .......... ..... Phone _.....---•.._._. ....... is Name ................. .. -- i Installation will serve: Residence [3Apartment House Commercial ❑Trailer Court ❑ f : Motel ther .--T�.�.`�-:---• � i Garbo a Grinder ..... ...... Lot Size -------- ----------..................... '. Number of living units:.,.._(..-,: Number of bedrooms -- -------- g I Private } Water Supply: Public System and name ... --•-- ------ ---------• : ----•--- - - - - - j # . Character of soil to a depth of 3 feet: Sand❑ ilt❑ Clay ❑ Peat[JSandy Loom Clay Loam [] b- w- i t ` Hardpan Adobe ❑ Fii[Material _...... If yes;type ---- I ,..location of system in .relation to wells;. bild+ngs, a-`�`t u (Plot plan, showing site of lotst be placed on reverse side:) NEW INSTALLATION: (No-septic tank or seepa e.pit permitted, public sewer is available 2q0 feet,) F I Sizes'- f Liqv+d Depth ... ............. PACKAGE TREATMENT SEPTIC TANK .~ / Not. Compartments - -••-- ! � _.6Capacity, TyPet .�o�lNaterar I } f ( i Foundation ... . /. Prop. Line ..__. k . : istance. to nearest: Well . /.f�U...'- ----•-:-- --{- -��O'� ��.. » ' Len th of each line. . :._.i.................. . Total Length ._.. .-----••--••• I LEACHING LINE ( o. of Lines - ,f-.._ .. _ `g /f DBox es Type Filter MOteriatS�:,, Depth Filter Material i Distance'-to nearest: Well �.Pd-�� -- -- Foundatiori /U -- ; Property Line -:--.. ---••.---•----• SEEPAGE Diameter7-Xl-1!.�.'__ Number `_.;— ;-------.---1 Rock Filled Yes j�No ❑ GE PIT [ Depth /a- ..R Size i + Water Table Depth otk S' e - iI v . nd ation: i ._._ Prop. Line nearest: Well .-- ® �---=- <- -••'-FouDistance to # rmit# ----::- REPAIR/ADDITiQN(Prev. Sanitation Pe - Date --------••`.............. 1 .Septic Tank (Specify Requirements) ... -- .............. :Disposal Field (Specify Requirements) ...--- s. `T l� f ` �-—. �'—. i....�.1.— ... -_...---'"------------ -------------•----'-• 1 .... ...... ---------- ---------------- --- ----------._... -.._,_...------ +..."�. - r .-__ ..'Y `i ............... .----.-----------'c-_....--..-_-.-•.._..._- -... i (Draw existing and required addition on reverse side) " y I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin s of the San Joaquin local Health District. Horne owner or licen• County Ordinances, State Laws,'and Rules and Regulation 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 inTucl+manner as to become subject to Workman's Compensation laws of California." Signed _ Owner Ti BY (If other than owner) FOR DEPARTMENT USE ONLY Y } APPLICATION ACCEPTED BY .. c-!/ -' '-. . DATE ._�. ............... .'....Y BUILDING PERMIT ISSUED __--__-..: .......... .. ...... ...... ......... .... _.__..- DATE _.... i ADDITIONAL COMMENTS -- --,1-i------ --------------------------------------------------------------- .....-.-... -_...,_-.. :.. I ------------------ - ------- ...... .-_.-----•--......- • ._. ._ ' -- -----. ---- ........_.- ----........ ---------------- .................... -------------- .............. ......_.. ........ Final Inspection b . ---- ---- .Date -./ .P-."'1.�.._�. .._ .. Ep y. -----.--- _._.._ - •.� SAN JOAQUIN LOCAL HEALTH DISTRICT . 7/72 3 M. -