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FOIL OFFICE USE- <br /> ....... ....................:................. <br /> APPLICATION ICOR SANITATION PERMIT <br /> Permit No. ?S`..... <br /> �.. <br /> -.IComplete in Yrlplicate).. . <br /> ._.__...._-- This Permit Expires 1 Year From Date Issued <br /> Date Issued <br /> s 33 . ;;�- t r 1. 21 - oto-�l <br /> Appiic tion Is hereby ma a 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 Regulations: <br /> 1. JOB ADDRESS/LOCATI N �Y�c -- � <br /> . ... ._.........` .....................CENSUS TRACY <br /> Owner's Name --••-..... .... .................................................. _......PhoneYz1__77j`L-••• <br /> Address ......... .... .�_...d. -zc .......---- <br /> ---- --• -�t.� ---•......................................City _ .. . . ....._..._._._......_...••••----•••----- ------- <br /> Contractor's Name S® � S 3_-__-- phone 6d fdD`J <br /> �t ........:.......License ... :3 ...----- <br /> Installation will serve: Residence©Apartment House Commercial Ofraller Court 0 <br /> Motel ❑Other... '................. <br /> Number of living units::.:,-___--n.Number of bedrooms ..._ Garbage Grinder ........ Lot S ze�^ - - •.....•.. <br /> Water Supply: Public System End name --------- ... ..::!' _........ .....: . .. . �i�` r .�-Yr�4 .......Private <br /> Character of soil to a depth of 3 feet: Sand Silt 01 Clay p Peat❑ Sandy Loam �, Clay Loam fa S, <br /> Hardpan ] Adobe fl Fill Material ...........!#yes;tyiie ` ; :' ..:_..:... w <br /> k .. I+3 <br /> {Plot pian, showing size oU lof, Location oVsystem ,In reEation to wells, buildings, etc,'�it�ust'ba placed on reverse side.) <br /> NEW INSTALLATION. (No septic tank or seepage pit permitted if public-aeWbe-is avoildble within-200-frot,) <br /> r • . Liquid Depth _ „SSS i <br /> i PACKAGEitE:ATMENT_ []:�..SE:€�TIC.TANK_ $ize_..,•1�._.X- ------------------•------- <br /> - ...... <br /> Capacity jl!C)? ___-- Type ............ ....... Material .. No. Compartments L .... <br /> Distance to nearest: Wei 3 ..... ........................: Foundation ...rA_._...t::.._ Prop. Line _5............... <br /> LEACHING-LINE•....[- No:Mof.Line :- __- __ --�Lengfof eadt Ilne�= �p � -t=-.------ Total Length .__�I ...�.....•' <br /> D' Box Type Filter Material ../ - .....Depth Filter Material ......l.F..r._•..........:..........' <br /> Distance to nearest: Well ------------------------ Foundation --- ... Property Line ...,.F". r 7`....._: <br /> SEEPAGE PIT [ j Depth ------•------------- Diameter Number ....... ................ Rock Filled Yes C3 No C <br /> Water Table- ---- ------ ----- _ <br /> Table-Depth ------•----------•--•---------:Rock Size --------------- ; <br /> �... - � r <br /> Distance to nearest- Well Foundation .................... Prop. Line .---....----•---•-••--- <br /> REPAIR/ADDITION(Prev. Sanitation Permits :-0.......... Date ---:--------- ) <br /> Septic Tank {Specify Requirements) . 3 .......:._.. - ,....-•-•••-- <br /> --------------------•- � -- •i- . <br /> Disposal Field (Specify 'Requirements) ........................................ .................................................-_....................._..:_............... i <br /> r <br /> ­----------------------------­ ------------------------ ----- <br /> ........ -------.............................................................. <br /> • ^- (Draw existing and requiredaddition on reverse side) <br /> 1 hereby certify-that h e prepared this application and that the work will be done in accordance witty San Joaquln <br /> County`Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health:District.Home owner or licen• � <br /> agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, t sholt.not employ any person in such manner i <br /> as to become subject to Workman's Compensation laws of Ceiiifornio." j <br /> Signed -- - ------- ---- ..- Owner i <br /> BY - . ---•----- Title ...... .... t................ ...... ......................... <br /> ----... --:-- :�- i <br /> { of er hon owned -- <br /> I EOARTMENT USE ONLY <br /> r <br /> APPLICATION ACCEP ED BY -------------------------------------------- DATE..-.. ------_.------ <br /> BUILDING PERMIT ISSUED ------ • ....... .............. c- .._.......--_. TE . <br /> AD ITIONAL CO MINTS __-- _ -__- -.:___ _ <br /> . -- ------ - -- S �• - ` ------ ------- ----------- ••--•-. ..--/ -----------------.._..-----•-----------.- <br /> ....... <br /> ��: -_._... . .. •---•• C� ,�� P {�` j'P --- - - - - -------------- ------------------------------------------------------ <br /> .. -�... .......... -•-•--•---------.._._._..._... .............-- ..........................----•-•..._. ...._-....-._..............-----•--- <br /> kIna! Inspec on by. --_ .....................................Date _41-1-51-75 -- <br /> ' 1H 13 2h 1-613 ! SAN JOAQUIN LOCA* SEA-LIN DISTRICT8/74 3M <br /> i= <br />