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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 ..... ........ 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 � ith County Ordinance No. 544 and existing Rules and Regulations. , JOB ADDRESS/LOCATION . -. __. ..... ....... r_... ..f� .. ------- .................CENSUS TRACY .......................... Owner'sName ....... IRPhone ............................. ...... Address ...... Vii.. ` .. .. . .. " F City - .................--• -•.................................. Contractor's Name ....C`_.— - `G c(� ._.r..0�-�'._... L�- �r �t: »C-.-License Phone Installation will serve; Residence [Apartment House❑ Commercial []Troller Court ❑ Motel ❑ Other ..................:........... Number of living units:....`.... Number of bedrooms ... .{.-...__Garbage Grinder -19�7. lot Size ....../1y X�.-7� 7 Water Supply: Public System and name ..... , �i --_-------••----_---------- ---_---•---•---------.Private ❑ ' Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy loom ❑ Clay Loam ❑ y Hardpan ❑ , Adobe° Fill 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 per;nitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTICTAN K'S ] �. f Uzi;" ....................... Liquid .Depth ............... Capacity .. ._ ?---- Type .................... Material....................... No. Compartments Distance to nearest: Well . ... ................_-----------Foundation ..............:........ Prop. Line ..................... LEACHING LINENo. of Lines _ Length of each line........'K47. ....... Total Length __._ ........... D' Box Type Filter Material -.-Depth. Filter Material .............� -� � ..._....... Distance to nearest: Well ../;1U:.4f Foundation . . __P......._.' Property Line ...... `.'. ._ Diameter _rr' SEEPAGE PIT Depth ._... Number Rock Filled Yes No (] Water Table Depth ..._.. �.,.r ------------------I-------Rock Size - Distance to nearest: Well ------ -- '__...: ------...Foundation ....f.a.' ... Prop. Line _S................ 1 REPAIR/ADDITION(Prev. Sanitation Permit# -------__....- Date ..................................1 �- Septic Tank-{Specify Requirements) ..... ._....- ---------- --------- ' ....... .,. Disposal Field {Specify Requirements) G ...- v? F � � w 4 . (Draw existing and required addition on reverse side) •� I hereby certify that 1 have prepared this application and.that " the work will be done in accordance with San Joaquin 4 County Ordinances, State Laws, and.Rules and .Regulations of the San Joaquin Local Health 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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed .... . ....... . . ...................... .... ��.. . ...-_--'---•------------------- -- Owner - By .... - 2 - Title . (If of er than owner) FOR DEPARTaAE FUSE ON Y APPLICATION ACCEPTED BY ... ....... . ..... ....... .. .. . . .. � . --- �. . •-" - �- : - -r ,...,. DATE ...�'za��,Zs..................... BUILDING PERMIT ISSUED .............. - ; . .. : ._.:.' ADDITIONAL COMMENTS .................. ......................................_-'..................... .......... .................... ---•-- .......................... ------..-....._.. " ---_-------------- .............•--- •----------- -------•--....----'-......._.... . .... ...............................................'--' <-'--'-•'-------------_-----------= .._._.._... Final inspection by; ----------------& -1...... :.._._.,:__:._........ ..-.Date . S �/ ' AN JOA-QUIN LOCAL ;HEALTH `DISTRICT E. H.13 24 1-'68 Rev. 5M 7/72 3 M