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E,OR OFFICE USE: <br /> ' { <br /> APPLICATION FOR SANITATION PERMIT <br /> '=` <br /> (Complete in Triplicate) Permit No.7- -1-- <br /> __37 S <br /> ' --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health Disttf`ct#for`aj permit to construct and install the work herein <br /> describe This appl',cato rs m de iYr—�impliarice,with-Count -Ordinance,No.-5Q9�-and existing•-Rules-and-Regulations: <br /> L�f7 } of&rraj �ly�low4VAPico Road Between 'racy Boulevard <br /> I JOB ADDRESS/LOCATI i N A.li-._C_Qrr_al-_HO11oW__-Road.}--Tracyi-_-Gaa--------------CENSUS TRACT ------------------------ <br /> Owner's <br /> _-__________. ._ __ <br /> Owner's Name ------�. � 7- --- ----------- ------------------------------------------------------------ Phone 8351302-8 <br /> Address --B- �_treet------•-- --------------------------------------- Ci#y Tra I <br /> r ----------•---------------------- <br /> Contractor's Name elf---F------------------------------------------------License # ------------------------ Phone ------�------------- <br /> Installation will serve: Residence)MApartment House❑ Commercial ;❑Trailer Court ',❑ <br /> Motil ElOther <br /> Number of living units:-:._1_f_ _ Number of bedrooms ----,�____-Garbage Grinder ------------ Lot Size ---1OQ <br /> 5D + Qf't,--------- <br /> rr i' - t <br /> R Water Supply: Public Sy, tem. nd ,ame - --------•------------------------------------------------•---------------------------Private <br /> Character of soil to a d4pth oft3}ffeet: band'❑ Silto Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam® <br /> le t�i� Hardpan ❑ Adobe ❑ Fill Material _____.______ If yes,type _________ _____________ <br /> IE t-- <br /> (Plot plan, showing sizelof lot, location lof system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION.. No septrcftank or seepage pit.permitted if public sewer is available within 200 feet,l <br /> PACKAGE TREATMENT I l <br /> {C7 C+7Af�K Size / Q Liquid Depth j � <br /> apaci - ----- Typ 0 /_?_-Cb f aterial__ -0-d(_>____--_ No. Compartments <br /> Ct LDitance_to nearest: Wel ______ ---Foun ation_ (,Z____`__ Prop. Line <br /> LEACHING LINE [ ] No. s _ Length of each line._____-_- __________ _ Total Length ___- _--"r <br /> ----------------- <br /> i <br /> D' ox ._fir_- T _---__ '.Depth Filter Material -------------------- <br /> 'D' <br /> ----___._ - <br /> y �I ype Frlter Material <br /> 1 /�tt � - <br /> yWill _ <br /> Distance. to nearest: Foun anon _ <br /> � � . �---------------�---- Property Line ----------------•->•-•--- <br /> SEEPAGE PIT [ ] /Deh�__� _ Diameter -___-_______-__ Number _..?i________________i---- Rock Filled Yes ❑ No .0. <br /> AW W ter%Tadile.Dep�h«� - _ :--------------- -�---�Rbc`k Size ---------- --------------------- - <br /> �� <br /> ' 'Ctf tac�4 <br /> t ,I.. ance4to near st:,Well ---------- --- --- .-FoAJation -- �'----- --- Prop. Line -•-------------------- <br /> REPAIR/ADDITION(Pev. Sanitation.Pe it�# --___ __---- ____ ata _ ____1� � ._� -_� <br /> Septic Tank (Sp'ecif Re urrements <br /> Disposal Field (Sp�cify :Req�i irements} _ __________________ ..,.�--f _ _ # ; <br /> R (� - �_- <br /> -- --- ---------- --------------------------- <br /> ---------------------------- <br /> ------ <br /> --- ------- ---------- ---- �- �- - ----------------------------------------------- - ------------------------_--------------.--------- <br /> --- ---------- --- <br /> �" -- ----(Dra exist =---------------- - f --i--- <br /> ting and required addition on reve <br /> rse side} <br /> I hereby certify thatfl have prepared tla",is ppl cation and that the work Will s d"one in ccordance with San Joaquin <br /> County Ordinances, Stat Law and Ruies,.and-Regulations of the San Joaquin_LoCal Health District. Home caner or licen- <br /> sed agents sig re certifies the following:= �� ..fiteilkpiloy <br /> "I certify t t ih performanc�of the�worrk for which this permit is issued,-I�hall any person I such manner <br /> as to b u.bjec .tolWorkman's,Co.maa-pensation,laws,of California." � 4 � J� <br /> Signed <br /> ' t �� ���_ �Owner _ _! <br /> r <br /> By ---- -- -------------------------------------------- Title-------------- 7F ---------------------------------- <br /> (If other than owned <br /> EPAftTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ___ __P__ <br /> 1l11 y� <br /> -------------------------------------------------------- DATE ----7-------- <br /> ABUILDI <br /> DDITIONAL <br /> PERMIT ISSUED .------ ------ ----------------------------------------------------- --- DATE ------------------------------------------- <br /> ---ADDI7IONAL COMMENTS ------------ - <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------- --------------------------`--------------------------------------------------''---- ------- - <br /> Final Inspection by: -------------------------- -------- --------------------- ----- - -- - ---- --------=------- <br /> ' �� Date . <br /> SAN JOAQUIN LOCAL NEA DISTRICT- <br /> E. H. 9 1-'68 Rev. 5Ma' <br />