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V. FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT _ .................................................. ..... (Complete in Triplicate} Permit No. i . ......................:......... This Permit Expires 1 Year From bate Issued Dote Issued .1.�^...�.7. r Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work heroin F described. This application is mode in compliance with County Ordinance No. 549 and existing Rules and Regulations: r JOB ADDRESS/LOCA N .............. �.3 /��....�7Q t �4- ...... .................CENSUS TRACY ....................... Owner's Name.... ..... .. GY ........... .......XN- _ -+ Phone Address .................. 3. .. City / . �.,./. . Contractor's Name ...........: ... :... .. ... ... ..... ..:.._. :._....__..:.license L:17.�- . ._ Phone / 3 " 4 .._..._ '. Installation will serve: 'silence Apartment-HouseE-Commerciol-OTrai(er Court.-E - t Motel (]'Other .....3.........:.........._...........__. Number of living units ..... ,__... Number of,.•.bedroomsw.. _._.....Garbo a Grinder. ... .` ., Lit-Sire .._."-. xl: ............. . Water Supply: Public System and name .............._... .......... _.........----......_:... _. .. ...Private Q Character of soil to a depth of feet: Sand d Iiilt Q Clay ❑ 10;2D 'Sandy„L•odm 0 Clay Loam 0 Hardpan r[�y Adobe Fill Material ...... If yes;type ...... (Plot plan, showing size of lot, location of system• in.relationAo Is, buildirigs, etc, must be placed. on reverse side:) NEW INSTALLATION: (No se tic�ttannk.,or seepageitipermitted if public sewer is available within 200 feet) t v PACKAGE TREATMENT O S PIT C TANkix] Size._..------------...................... Liquid Depth ►� �--� - Capacity - Type ------------------ Material. i......;.... ._._ No. Co portments .................... Distance to neor.•6t: Well ............. ....:.........F`undaatl&, ........ .. Prop- QrJ _>......... LEACHING LINE No. of Lines _ _ ` { ] t s Length of each line .1. _:._...Total Length _. s' . . . . ....:.........DeplhTFi ter ateria . . p-....._.__.. QE Pro� pe r •� , � rG1D.rsr�ce to-ne�resli Well er:Material # Foundation p rty 11 } e Line -- SEEPAGE PIT [ ) 4>j pth Diameter ..............i: Number . Rock Filled YeV �F10 JP Q t Water Table Depth .....:.:..........:..........-_-.f_ -Rock Size �� Distance to nearest: Well .Fo�rad_a_tion 1 REPAIR/ADDITION(Prev. Sanitation Per it�# .•....... .....................f......._.... -Doti .......................I I f Se tic Tank (S • -Septic pacify Requirement{si 1`Q+[, ._. `k. - .. .. ~'7` V~........... Disposal Fief (Specify Requirements) -_e.r.N..._,,Arti.. ............. .......:........ ........: ..... ---........ .........._.............._.. ....----. W.1 yet t ��✓ ....... . ......................... . . . .............. ... ...........------...... ......... ........ . ........_.............................. :. .. :-#................ ..t,.a.... . . .._.•. ..__.............__. ....................4.................. 1{praW existing.and_regvire__4ddition on reverse side) l I hereby certify. that I have prepared this application and thatttt the work will be done in acro I dance with San Joaquin County Ordinances, State Laws, one Rules and Regulations of the San,Joaquin Local Health-Dlsfr�ct. Nome owner or liceth sed agents signature certifies the following: "I certify that in the,performance of the work for whichil�w tht i iss , I shall not employ any person in such manner~' i as to become subject to Workman's Compensation raw—$'-of Calif ;a." Signed er.:.. .......... _ .- Own By ._.. .. - ; l ' r J - - (If o -er n owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .. ....... DATE ........ ......... ' BUILDING PERMIT ISSUED •.......................... ...........................................................:... ..............DATE ...._.._..---...-- ........ ADDITIONALCOMMENTS .............................................___--..--......-___-........---._-..-:............................... .............................................. .... ............. ......._...---:.--------........-.......... ,.............................- -.- ................................•••... ......................... . ...... .. .................................... ........................:.... . ...:...... ` _` .._ ...-- ---•--•• Final Inspection by: ..... t' Date ._. . _.. ,SA JOAQUIN L"6CAL HEALTH .DISTRICT E- 14.13 241.•AA Qav SAM 7/72 4 M