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70 FOR OFFICE USE: p p APPLICATION ICOR SANITATION PERMIT ...............•--• f ....... Permit No. (Cotttplate In Triplicate) Pe ....... ......_ �... .. . ` This Permit Expires t 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 with County Ordinance No. 549 and existing Rules and Regulotionss JOB ADDRESS/LOCATION .... / f, .t11..... �". .......................... .....CENSUS TRACY .......................... f. Owner's Name -. . ----....- ......... Phone ._ Z....-- -----.rte ..----- / // :- . . .... .. . . Address __...... !• 14....._�.' F .. . .....Ci - , ty ... Contractor's Nome _....._.... ----------------- ---------- -------License i�` p23. .1? JZ.. Phone ._.._r'o `r�f4 7 Installation will serve: Residy r❑'Apartment House fl Commercial❑Troller Court E '-Motel❑Other Number of living units:------- .. Number of bedrooms ..Garbage Grinder ..-•----••-. Lot Size a .... .... ................. Water Supply: Public System and name ' �- ---�•—^-� ....._........- _..._........_...---............. -.........Private . Character of soil to a depth of 3 feet. ;`Satnd❑ Silt❑ I Clay ❑ Peat❑ Sandy Loans 0 Clay Loam I lar'd?on(j Adobe Fill Material ............ If yes,type•.............. ....•___.... (Plot plan, showing size,of,lot, location of system in relation to wells, buildings,,etc..must..be plated on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK{ ] Size_____________•_..•I-_ _ ......................... Liquid Depth .--•....................... Capacity _:!!";_!J_._..._ Type ------•--.---_-_'__. Material...................... No. Compartments Distance-to ngares Well ----------------_- � ° 6' -�..-------------•_Foundation .......... Prop. Line _ ... LEACHING LINE [ ] No. of linesEon t g of each•-Ilne�............. :.-. .Total Length ; •D' Box ............ Type Fitter Material -------•--- ........Depth Filter Mate dl _._.._.!.......................... ......... . f � Distance to nearest: Well ...... ................ Foundationi ........................ Property Line ...................... SEEPAGE PIT [ ) Depth .--•-•- .__-•- --- Diameter. --------- Number--_- -------------------- Rock Filled Yes ❑ No ❑Q Water Table Depth`- - - -- --------------4............Rock Size --•-----•---• .................. �1 { Distance to nearest•�We1l)":..................•----_..5_..........Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Saniti n Permit# _......�.__. � � r . Date Septic Tank (Specify,,Requirements) ............................... •T ........ ---_•i . ........ ............-_.........,..:......__..... .......................... Disposal Field (Specify Requirements) ----- .------. ----• -- ..................................._..........--------- ----------------------- � ' 3 ° -----------------•----- (Draw existing and re uired cddit€on on reverse side) I hereby certify that I have prepared this app)ic&Jlion and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulatiohs of thaeSon .Joaquin Local Health:District. Hattie owner or licen- sed agents signature certifies the following: , "I certify that in the performance of the work for which this permit is Jssued, 1 shall not employ any person In such manner as to become subject to Workman's Compensation laws of California.". Signed ---- -------- - ._ -------- --- � � t - - Owner By -----------•------- - -- - - •----- #_----•--_-------.. _ ------� Title�_.._..._.. '..._...-.: (if oth r t owner) i DEPARTMW LiSE ONLY APPLICATION ACCEPTED BY --- --- ---- - ---------- ----------------- .._..�- � DATE _ ~`.. �.. 5 BUILDING PERMIT ISSUED ___.... ...__ ____... . -----------••------------- -- ......-•-------......- - -DATE ---------------------...................... ADDITIONAL COMMENTS $ -�. --------------------- --- -- ----- ---------------•- -- -- •--- ...._.................-.. ---------------------- --------•--•---------- ...............-----------------------------------.--------- ----- -----•---.- -------------- .3...... --------- _-----..._..........._. ...................... --------------- ...------y• �.--�-- -- .. •----------•---_ ...._._.. ___._.- / � .'� Final Inspection by: ..........1/:- �1 .............. jr�� {{ ...---...Date -..-..-1^.._ ._... _�__..._._.. EH 13 2 J-6 Y• SAN JOAQU LOCAL HEALTH DISTRICT 8/7h 3M