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ZFOR OFFICE USE: APPLICATIeWFOR SANITATION PERMITL Kermit No- __ --- �-------------- (Complete in Triplicate) ----------•----------------------------------i----------- Date Issued ____________ This Permit Expires I Year From Date Issued - Ea 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 c mpl.iance with County Ordinance No. 549 and existing Rules and Regulations: 37� S� 1;.1 t-A �I2'-r�a�3o ADDRESS/LOCATIONS �_ ` Interstate__#5_ &-Tracy Road -----CENSUS TRACT -------------- JOBI uNevJ.--- Owner's Name ----------------------Shell__0i1_-r'Q.mpany----------------------------------------- ---------------------Phone -----------------------'-------( i Address ------------------- --------------&an---F'-r'a cis.GO� �a. City ----------------------------- r: . '�ioo 11 � : 07__ _ License # Phon < r : r.:. Contractor's Name ---- Parrl>�h__$r__ s� IAC-,ti_ ' ----••-- Installation will serve:---- Residence E] Apartment House® Commercial ❑TrailerrCourt :E] Motel ❑Other ------------------------------------------ Number of living units_____________ Number of bedrooms ------------Garbage Grinder ------ Lot Size __2Q_0Ft_._x-_ -_Ftp-• X Water Supply: Public System and name - --------------------------------- ------------------------------------------------------- Private i Character of soil to a depth of 3 feet: Sand❑ --Silt El 4--Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam:Rk Hardpan [], = Adobe ;❑ Fill Material ------------ If yes,type -_----- ;�• n reverse side.) (Plot plan, showing size .of=lot, location of'system in relation to wells, buildings, etc. must be placed o ) NEW INSTALLATION: ` {No septic tank or seepage pit permitted '+f public sewer is available within 200`feet,) PACKAGE TREATMENT I 7p SEPTIC TANK:[ ] � � s Size------�7-L6----------------------;--5Z-'t- Liquid Depth ------------------• - w Precast- Concr`e - Z �.. Capacity 2 Q0- G- Type- •-: --=-- Material---------- ---------- leo. Compartments r t �•` !1-1254 Foundation 1.,10_�----------- Pro ,Line ------•-5- -------- Distance to nearest:. Well;---_-. ------ --------• -- Prop.,Line of en th of. each -line'- cath0_}_ Total Length ------3Q.;--------- ==---- Filter �3ed '• '�-'p'SBox *____-�-�'-- TYpe�Filter-Material ------Rock Depth Filter°Material ------2_______----•-------------- -, . . �. Distance to nearest: Well ---1125------------ Foundation -- �--- -------- ,Property Line --5.:-----------•----- 1 SEEPAGE PIT".. Depth --_X2:kX-----_ Diameter ________________ Number Rock Size ---- ,k Rock Filled. Yes ❑ No i❑ { Water Table Depth - - ---------------7- -•----; ' l Foundation ---- Pro Line _-----------------`--- Distance to nearest: Well ------------------------------=--- ----- .......... p REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------------=------------=-- Date --------------_--_--'°---------____) --------------------------- SepticTankTank (Specify Requirements) --------- --------------------=-------------------------------------------- Disposal ---------------------------------------- Disposal Field (Specify Requirements) _______________ _____ _____ ______'_ - - ------------ ---------------------------------------- ----------------------------------- t ( _ i -------- ----------------------------------------- ---------------------------------------------------------- (Draw existing and required addition onx_ reverse side.) W w R - , I hereby certify that I have prepared this application and that the work will be done in. accordance with San .foaqum County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or ficen- se_d-agen#s 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 1 as to become subject to Workman's Compen3ation laws of California." � Signed _-__-- Parrish 0-Ps_, Inc Owner ___-_- --_ Pres Title ------------- -- i ------------------ I (If other, than owner) FOR DEPARTMENT USE "LY ' APPLICATION ACCEPTED BY --------------------------- DATE _1 _------------------------------- BUILDING PERMIT ISSUED = _ DATE . - ---- ADDITIONAL COMMENTS ----------------------------- - ----- =------------------------- - ----------- ------- -------------------------------------------------------------------------- -------------- ---- - Final Inspection by: - --------------------------------------------------------------------------------------- -✓1 Date __ - ------ -------- SAN JOAQUIN LOCAL HEALTH R1CT I E. H. 9 1-'68 Rev. 5M