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FOR OFFICE USE: t APPLICATION FOR SANITATION PERMIT ----------- -----------•------..._... ........ ' (Complete in Triplicate) Permit No. ...71i-5a l _.................................................... This Permit Expires 1 Year From Date Issued Date Issued .._'�.--k: .-I3 I: 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/LOCATIO ......:_. .C� S v .G 7`en-n r.-._ <.- .._._.:. ... CENSUS TRACY .......................... Owner's Name ............ . .�. _ ``LX-��P �z r` ...---------•--.....---.................----..._......................Phone._._. ......, 4 �....._ ; Address ....................2.0--9 --_5__..._ /� ..! ........... City ............................................ ........................... R Contractor's Name - 2A • cT�l� c ......License # Phone '� Installation will serve: Residence partment House❑ Commercial [-]Trailer Court 0 e Motel ❑Other ........................................... J ' Number of living units:...-�.__.:: Number of bedrooms _�Fi�.Garbage Grinder ............ Lot Size...... G..................... . Water Supply: Public System and name ---......-................................................-............................................. r_.Private ❑ Character of soil to a depth of 3 feet: Sand Silt❑ Clay El Peat Sandy Loam C] Clay Ldiam 0' � Hardpan ❑ Adobe ❑ Fill Material .... ....... if yes.type ........ ...... (Plot plan, showing size of lot, location ofsystem in relation to wells, buildings, etc. must be placed: on reverse side.) NEW INSTALLATION: (No septic tank or seeps a pit permitted if ubwer is avilable within 200 feet,) PACKAGE TREATMENT [�SEwPTIC TANK t+j� Size............. ............... .......... Liquid Depth .......................... Capacity OW..... Type�f�-.� ..r.. Material ter. _ Na. Compartments ._.:...-............ \R Distance to nearest: Well _._. _, e•..........Foundation ..142................ Prop. One A2 ............ LEACHING LINE [ ) No. of Lines _._ __.._. g l3 Length : N Length of each line._-••- .---1......_..... Total len thi._- ................ 'D' Box j .-__Type Filter MateriaE�� ..Z". .Depth Filter Material .........�J......................... .... Distance to nearest: Well ... er___.__.. Foundation f.............. Property Lisle ._k°pr........... SEEPAGE PIT [ Depth.:.................... Diameter ................ Number ............................ Rock Filled 11 Yes ❑ No 0 �.. Water ;Table Depth {' . ........ ................:....:..............Rock Size ................ , Distance to nearest:Well............... ............................Foundation .................... Prop. Line ...................... .., �--� REPAIR/ADDITION(Prev. Sanitation Permit# --•--- ........................... Date ---.--...--------•..---•------___-) - Septic Tank (Specify Requirements) 4 Disposal Field (Specify Requirements) ' .:: ---•...................................•--•..............-•-•••..........-----................................... �'I ----•------------------------------- ------- -..............................-............................................................................................ (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application' and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Howie owner or [icon- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, i shall not employ any person in such manner as to be ome subject to Workman's Compensation laws of California." Signedn -------------------------------------- Owner [SITS $Y .......................—...----------. ------ ;title (if other than owner) ' FOR DEPARTMENT USE ONLY i ._APPLICATION ACCEPTED BY ....._...._-------------------''�t='-�-------••------.......... .,. ......... .............,,DATE ... -'41 7-3................ BUILDING PERMIT ISSU€D ... ........... -.......... ..DATE.............................. _....._ ADDITIONAL COMMENTS ........................� `'......------=-------- = "'.._........------......----- . L. ........................ --•----------------------------------- ......----------------------............-----------------•--...-------------•......... .......................................... ................. .....................................................................................----------- ..... ..._..._.................. ......................_._............................ ..._ ._ .. ..... - ...... .... ........ ... . ... Final Inspection by ................ 6a SAN .�.:�. . _. . SAN JOAQUIN •LOCAL HEALTH DISTRICT - E. H.13 24 j.'68 Rev. 5M 7/72 3 M +