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v FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ..................................... �Z (Complete in Triplicate) Permit No. ... : ..........., .......... .......... This Permit Expires 1 Year From Date Issued Dote 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 with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ...,..... .133- ...,.. .................CENSUS TRACY .......................... Owner's Name ....... Q... .... .:.. ..... .. • • '- .......:............... .... �. g6�....... Phone Address .............SLC.�7 ....-•'-..�/.!!F.R'......p....................._........ . :ty .��.�.�C7�...................I........................ Contractor's Name .------,/ i4--�U.��:.-.t�.............................::........L cense a'�� 6.. :. Phone .P c�-•��f��. Installation will serve: Residence ®Apartment House Q Commercial ❑Trailer Court 0 Motel ❑ Other.....''..//..........:......................... s7 Number of living units:----(...... Number of bedrooms Al......Garbage Grinder ............ Lot Size CA .ef!�................. Water Supply: Public System and name ... ......................:.._....-_.............. ' ..............---.....................Private 19 Character of s it to a depth of 3 feet: Sand❑ Slit❑ Clay ❑ Peat❑ Sandy Loam O Cloy I oam Ig Ho dean ❑i Adokie;'❑ Fill Material ............ If yes, type ---------------- --------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLtTiON: (No septic tank or seepage pit permitted if public sewer is available within 200 1 eetj i PACKAGE TREATMENT ( ] SEPTIC TANKI ) Size...r yd{..K..`��......------ Liquid De �� .............: W Capacity 15 ...... Type RYC4P . Material...................... No. Compartm ints ... W Distance to nearest: Well ..... .45. ......................Foundation .......... Prop Line ...................... LEACHING LIP1E [ ) No. of Lines ....2............... Length of each ,,,li e...f..QQ................. Total Lengt>rl .........._............... ( 'D' Box ....I...... Type Filter Material 14'2.XA;�A-Depth Filter -Material ...../1 ............................. Distance to nearest: Well'..... .Q Foundation ........... Property L ne ........................ SEEPAGE PIT ( ) Depth .eta............. Diameter #X .A Number ....!; ................. Rock Filled Yes ® No O '51Lo o If I Water Table Depth ................................................Rock Size .......................... ..... P Lv0 r-f- Z-3 `t Distance to nearest: Well ........................................Foundation .-_. ......... Prop. Line -.................... y REPAIR/ADDIT ON(Prev. Sanitation Permit# ..............._........................... Date .................................. ) Septic Tank (Specify Requirements) -----------M.............................I........ .............................................. ................ Disposal Field (Specify Requirements) ..................... .................................. ........................._............_... ........................... .................................................. ................... )-.....-......................................................................... .......................f....................................................................................z 3 (Draw:existing and required addition-on reverse side) 1 hereby certify that 1 have prepared thisapplicationand that the work will be done In accordance with San Joaquin County Ordinances, State Laws, anTl-Ro►eTadd4equlatlons of the San Joaquin local Health District. Hoi to owner or licen- sed agents signature certifies the following: :.. -. _f-" 4,-- ^ '� "I certify that in the performance of the work for which this"pernitt:,Ia 7aaued, 1 shall not employ any pen on in such manna as to become subject)o Workman's.Compensation lowt of talHdrnla. ' Signed ......:...01 .'.' ---------------- '.'.'."'- By . . .. .. ........(............ ........................................................... Title.-'--..r,.... .......................................... .......-...... . (if other than owner) FOR DEPARTMENT USE•ONLY APPLICATION ACCEPTED BY ..... - '................................................:...:.................................... DATE ..................... ...BUILDING PERMIT ISSUED .......................•------------- --•=---•-•---=--------------_....--- DATE _.........--•--........................-' ADDITIONALCOMMENTS .:......................:........................`-r.........._.._.:.. ' __......_..........................:. :..:. ........................_...........--------------------............ ... -------M......................... .. ..._�........:r.....: ....`...!..........................................................................................I......... Finallns ectionb .......................... .......Date .-. e"-7. ........... SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.13 241-'68 Rev. -- - - `' 7/72 3 M ��