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FOR OFFICE USE: ....................................... APPLICATION FOR SANITATION PERMIT ,.-�� j3 Permit No.' - (Complete in Triplicate) """ ......--•.........................._..._.:--.................... Thls Permit Expires 1'Year From Doff 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 wit County Ordinance No. 549' and existing Rules and Regulations- JOB ADDRESS/LOCATIO 1..�_7 —� ' �_ ..u.. � .......... .....CENSUS TRACY Owner's Name ....... �lrr9_ ................--•............. ...........Phone Address ......... �. tQ------. ..... _ City . '/ ............................. ..'.......... ... Contractor's Name - ---- !ftc� _-- :.Ucense ./-- 3 ! Phone .............. - Installation will serve: Residence( artment Housef] Commercial❑Troller Court ❑ =� Motel C]Other....} Garba a.........................Grinder - ' . . Number of living units:......l•-.c Number of bedrooms ........... g nder ............ .Lot Size .......................................-� Water Supply: Public System and name .- private - .._----._..----.........-......... :.......... .. Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑''` Peat❑- -:Sandy` Loam �lay Loam ❑ Hardpan ❑ Adobe 0 Fill Material" if-y ............... ........ (Plot plan, showing size of lot, location of system in relation to wells, buildings,,etc.,must be .placed on reverse slde.}� NEW INSTALLATION: (No septic tank or see age pit permitted if public sewer is-available within 200 feet,} PACKAGE TREATMENT [ SEPTIC TAMC ] Size Capacity TYPe ��_`-�- Material....�4�-No. Compartments .............. . Distance to nearest: Well .................Foundation ..... Prop. Line ....1Y.,r ..... LEACHING LINE ( No. of Lines -----.-: .......... Length of each line ?. - Total Length ...16m; ......... 'D' Box ....I_---- Type .Filter Material __..: r ....Depth Filter Material .........I. ................. Distance to nearest: Well ......... °. .... Foundation ....t!04-4.......... Property Line ._. l_ ......... SEEPAGE PIT O Depth _............:.... Diameter ................. Number ................-............ Rock Filled Yes ❑ No 0 Water Table Depth ------ --•----•--•- •------_---.-.-...........Rock Size ................................ Distance to nearest: Well ---_-:.__- :..foundation ... Prop. tine REPAIR/ADDITION(Prev. Sanitation Permit - Date ................... .) Septic Tank (Specify Requirements).........--•_--•- Disposal Field (Specify Requirements) ---------- ..................................... ...:........ ........... --------------------- •.......------------------------.._....................................... --------- (Draw existing and required addition on reverse side) .• I hereby certify that i have prepared this application and that the work will be done In accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Hoolth,Distrlet. 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." Signed ------------- ••--------- Owner BY -u� - ��------ -.--- IitIe _.e-el ............... ............ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- •. ......................•-•----------------------. ..------..._....: DATE _� .2-r� BUILDING PERMIT ISSUED _..- ----•............................... :..:...'_ -•.........:__DATE ...... ................... ADDITIONAL COMMENTS ------------------------------= -...... ----------------------------------•--•--•------._.-_---------- -- • •------ - - ---------------........_....-----••-------._.. ..._- -------•---- Final inspection by: ...___-- ;- ... .................... .... . ........ . EH-13 2h 1-68 Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3m