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FOR OFFICE USE. APPOCATION FOR SANITATION PERMIT � �. - ...................... ........ �S - a� ' (CoPermit No. mplete in Triplicate} ....... k ..... this Permit Expires 1 Year From Date Issued Date Issued J�' 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: hlc0onald Island - Whiske Slou h JOB ADDRES5%LOCATION ......... ...... ......... ......• --...-...._.._........_y...__... ..g...........---...-•---........_.CENSUS TRACY .......................... Owner's Name -.._-.Pacific Gas and Electr c Company ' - ' 466-2261 ............................. ...Phone Address ..........------ 4040 West Lane _.-..---- -- -......... City ..Stockton •.......... ................................................... Contractor's Name ..Pacific Gds and Electric Company License # ........ ............... phone .466-.2261- Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court j] Motel ❑ Other . „ Gas Compressor Station Number of living units:.. ... _.... Number of bedrooms ............Garbage Grinder ..... ....... Lot Size -........................................... Water Supply: Public System and name ----------------- -------------------------------------------------•----. -------------------------....Private �] Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat[A Sandy Loom ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material .... If yes, type ...._....sandy. loam (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed .on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) capacity �_ �' A.-.___-•_-..__ Material..------ 1.�.Q11............. Liquid Depth ...._-.-..._._._...._..... N TREATMENT PACKAGE T W _ - 1 SEPTIC TANK Size....-- ��a n rete No, Compartments ._...... ............ \� p y 24,00 a ype _ re fab cont ... ...... Distance to nearest: Well .. 620-l..........:.. .......Foundation .....150'... .. Prop. Line ....790,....... _ LEACHING LINE [ ] No. of Lines . 2.. :- Length of each line .......4.5.'........:.... Total Length ....._.-........_........'., 90' :. 'D.' Box .._.- Type Filter Material sandy l0i iepth. Filter Material .... .:5........... ......I------------ Distance --- _.Distance to nearest: Well ........ ..... . 600:' - ------ _ Foundation .....1.70.`...:-�-_---: Property line .--------------------- SEEPAGE ----•---...--•---_}-SEEPAGE PIT [ } Depth Diameter --------------- Number . ----- Rock Filled Yes ❑ No Water .Table Depth _.._• --..-------------=.---------...........__Rock Size ..._..._-__._......_......_.____ Distance to nearest: Well ...:__...-_-.-- --------•---------------Foundation -.,.-------_ Prop. line ....... ............ REPAIR/ADDITION IPrev. Sanitation Permit# _.__....._..,..... --- ------•--•-----.._ Date ----•------- • -. ........_._._ .J Septic Tank (Specify Requirements) ------------------------------------------ :. -----:---................--•-.._........._..- . 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 Joaquii County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or iicert sed agents signature certifies the following: "I certify that in the perform nce of the work for which this permit is issued, I shall not employ any person in such manne� as to become s �e to W lcman's Co ensatio laws of California." Signed . .. .... 4!!/.. ---------- --- Owner By --- ---------------- zine Supervisor of Land Records._..... (If other than owned R. W. Houston DEPARTMENT USE ONLY � - APPLICATION ACCEPTED BY ..... ... . . .. .. ... ............ ... ............_.. ._...._..._.._.__. DATE ...I:�rJJ.-' 1 ......... BUILDING PERMIT ISSUED ._.... _.....................__....-•-..--...-_-----..-. ...__........-DATE _._._.-.._......._.. ADDITIONAL COMMENTS .... ......... ._....._.. ;.-_...... ._..:._... --...---•---------------------•-••----- ...................... •-- -- ------...----- •--._._..._•--- ---•---- ------- � Final Inspection by: ...._ _ :...._,...._.. Rate _...)7"`�.� ' = o W �.. N J UIN LOCAL HEALTH DISTRICT E. H 13 241-'6B. ev. 5M