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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. / (Complete in Triplicate) ----------------------------------------------- ` _ __ This Permit Expires 1 Year From Date Issued Date Issued __. �,6-74 Application is hereby made to the San Joaquin.Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOS ADDRESS/LOCATION .-__ 920 Lorraine Ave. Tracy! Cad-iforn a__�_ _ .CENSUS TRACT --_______....------------ Joepgnaza' �- .__Phone ---------------835__0549.__ ,,,,Owner;swName . ..t "I- ------�------ _ it n Trac - Cal - orna a- --------------------------- Address ------------------------------ --$20 S- ----r-----------Street-----------=---------- ------ City --- y� Contractor's Name ------------------b,A_.__-F2trri8h__&_ S2X1 -- i7t ----------------License # ------1Q 511----- Phone ---.,4669-607....------ % i •, % 4% Installation will serve: Residences Apartment House❑Commercial❑Trailer CouErt `❑ j ._ .,.�_._Motel-❑.Other,-- ------------------ j 1 Number of living.units:.__l------ Number of, bedrooms ___!4------Garbage Grinder ----X10-_ Lot.Size _75--&-290--------------------- { Water Supply: Public-System and name _m�--------_.. ----=------------- Private g] Character of soil;to a depth of 3 feet: t Sand❑ Silt® _Clay .❑ Peat❑ Sandy Loam -❑ Clay Loam -4Har`d'pan ❑ Adobe❑'°Fill Material --___._____ If yes, type ------------------ (Plot plan, showing size of lotrlocation of system .inrelation�,to.:wel.1s,,6ui.id_ings,,xe.tc. must be placed on reverse side.( �A t . r : r NEW INSTALLATION:' (No septic tank or seepage pifi permitted if public sewer is available within 200 feet,) I 2 PACKAGE TREATMENT X] SE�PTIC`T,ANK.`[_]' t Size_,._,-12x,5X_5------------------- _______P__ Liquid Depth _________ _`.r \ I �.Capac�ty 18W'-gal Type''prec ---- Material `coner to .No. Compartments ------_2 1 a toneaiestd 1Ne11 --- ------ Ot----- --Foundation0. s-t--------.--- Prop. Line --- - --------------- 1. 1Distant Iil --...� lt0tQr 11 r 200' LEACHING LINE ( ] No. of 'Lines '__3__ _ _______ _____ Length of each -Ime,_________t_____._��_._._,�otal Length _.___ _ Y - - # p Box`-- --_ Type Filter Material -1 --{----------•Depth Filter Material _ tt--------------------------•-•-•------- •+ r e ., -7 Distance ta,nearest: Well _____ _0'=`- _:__ Foundation3- !_ __/Property Line �___T............. I e,,- T SEEPAGE PIT . [ ]. Depth __._bx Xb----- Diameter ________________ Number ____.., -)--------.._ -_j Rock Filled Yes No ❑ s _Rock Size - 1FT92 ------------- ._.«4. Water able Depth ----- �� - Distance to nearest: Well --------100.1_-----------------------Foundation ---loE---------- Prop. Line ---5-____._. - REPAIR./ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ------------------ --.--------} Septic Tank (Specify Requirements) - ------- --------------------------------------------------------- -------------------..__ -------- -------------------- Disposal Field ti (Specify Requirements) 1 4 t_ existinan -- --- ---------- - ---------------------- ---------------- ----------------------------------------------------- ------ ----- tt w (Draw pp g d required addition on reverse side) that the work will be done in I application and accordance with SanJoaquin I hereby certify that I have prepared this a County Ordinances, State Laws, and Rules and Regulations of.the. San Joaquin Local Heal District. Home owner or licen- 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 manner as to become subject to Workman's Compensation laws of California." 9 Parrish & t BY .�' - Title - -- -- -- --=--------- -------------- -------------------- --------- - - --- �- ` (If other than owner] FOR DEPARTMENT L! E ONLY r s Y' APPLICATION ACCEPTED BY -------------------- ------------------------Z ------- ----------- -- ---- --- -------- DATE _ !_ -------------------------- a BUILDING PERMIT ISSUED ---------------------- -------DATE �---------------------- ---------------- ADDITIONALCOMMENTS -------------------------------- -------------------------------•-------------------------------------------- --------------------------- ------------ --------------------____--------------------__----__---____------------_-----------______-----------_ -----___-----___________ _-_______�----______ ___-`�� ._________ .. ------------- ------------------------------------------------ - ---_-______ + - FinalInspection by: -------------------------------------------------------------------- -- -- ---------.Date .-�_7_' - ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT `` E. H. 9 1-'68 Rev. 5M