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FOR OFFICE USE: Appucxnm rat swuym PERM <br /> .................I................. . <br /> :(Complete in Triplicate) Permit No. <br /> ...................................... . . . ... <br />....... ... .. .. <br /> ..... .............................. <br /> ............ This Permit Expires I Year From Date Issued Date lit-Wid P <br /> Application Is hereby made to the Son Joaquin Local Health District for a permit to construct and Install the work herein <br /> described. This application Is made In compliance with County Ordinance No. 549 and existing Rules and Regut6tlonss <br /> JOB ADDRESS/LOC&.TION ............. CENSUS TRACY .................... <br /> .. .............. .... ...................................... <br /> Owner's Name .......................................... ..i............... ..................Phone ........ ............................ <br /> Address ....... ity ...................................... <br /> ....................................... 1p�.............. <br /> . ................................. <br /> Contractor's Name .................. kense ...... Phone <br /> Installation will servo, Residence(3Cpartment House 0 e6ilal,Mraller Court 0 im <br /> Motel 0 Other........................ .................. <br /> Number'of living units:-......:.... Number of bedr-0-9ma A Gr! er ------------ Lot Size .......................................... <br /> Water Supply: Public-Sy'stoT 'and name . <br /> .. .................6..............................Private 0 <br /> ,dt[3 <br /> Charactorof soil to a depth.of-3.feet:---Sand E3 Silto Clay 0 peSandy Loom 0 Clay Loom 0 <br /> Hardpan E3 Adobe 0 Fill dolorlal ............ If yes,type............................ <br /> (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc, must be placed an 'reverse side.) <br /> NEW INSTALLATIONS (No septic tank or seepage pit permitted If public sewer is available within 200 feet,( <br /> PACKAGE TREATMENT I I SEPTIC TANK f 1 Size...........7j................................... Liquid Depth ........................... <br /> �;_Copacity. ............... .. Material..................... No. Compartments :g=::............ <br /> ........... ........fd........Foundatlonlp.r............ Prop. Line ......... . <br /> Distance to nearest: Well. ...... 7. ........... <br /> LEACHING LINE No. of Lines ............................ Length-6f each line............................. Total Length .........I................... <br /> V Box ....1-..... Type-Filter Material- .....Depth Filter Material -24L..!.....................I....... <br /> Ae_d <br /> 010 <br /> Distance to nearest. Well ----------------------- _ Foundation ........................ Property Line ................. ...... <br /> SEEPAGE PIT [ I Depth .................... Diameter ................ Number ............................. Rock Filled- Yes E3 No C3 <br /> 4- Water Table Depth ....................... ........................Rock Size ................................. <br /> Distance to nearest: Well ........................................Foundation .................... Prop. Une .......... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ....................... ............ Date ............................ <br /> Septic Tank (Specify Requirements! ........... ............................................. ......................... .............................. <br /> Disposal Field (Specify Requirements) .............................................. <br /> ............. .......... ................................ ............................................................................ ..................................... ........................ <br /> ...................... .--------------------------------- ----------•-I.................................I............................... ............................................................... <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will he done In accordance With San JoaOuln <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. ".*me owner of licen- <br /> sed agents signature certifies the following: <br /> "I certify that In the performance of the work for which this permit is Issued, I shall not employ any person In.such manna <br /> as to beco;, bl ct to�W �l rt'a Compensation laws of California." <br /> Signed ... . . . . ............................................................. Owner <br /> By ................................................................. ............................Yitle ...................... ....................................... <br /> Of other than owner) <br /> FOR DEPART ENT USE ONLY <br /> APPLICATION ACCEPTED 8 Z <br /> ........................DATE <br /> ....... .............. <br /> BUILDING PERMIT ISSUED ..../_�_-1�................................................. ....................DATE .............. ................. ........ <br /> ADDITIONALCOMMENTS ............ ............................ .....................I....................................... .......................L............. ..............I <br /> . ...............I............. ......................................................................................... ..... .................................. ............-...................... <br /> ........... ...... ............................. ................... ....... .......... ............... .......I....I........ ..........I..... ......... .............. ...... ..........I......T <br /> ........ ......... ................. ..-.......................... .......... <br /> -77.............. <br /> Final-" 'inspection b­y, .......................... .................... ......... ......................... <br /> Date ... .... <br /> EH' 13 2h 1-68 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/711 3M <br />