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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 3 1Complete in Triplicate} Permit Na. -...........•--..-•....... .-.......... This Permit Expires 1 Your From Date Issued Date 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 ::.......969 ..NPP_hY.. R'o ad....-- .._. ." ...... ....... ............... ......CENSUS TRACT .:........... Vineyard Property Owner's Name ---------- ---- ---- ---•--. -- ---- .."........... .................. �...." :........:.. .".......Phone ........ , Address ..................9691:..MtzrPhy._Ro•ad............................................ City -----•--..-.-_--_-_--.........................................:.......... Contractor's_ Nome _._.__ ..........................................................Rooter Sewer Sex'.___ .. ... _.............License # ...�'WZ7.1S_�one .....? 5- ------------------ - - Installation will serve: Residence ©Apartment House Commercial❑Trailer Court 0 Motel ❑Other ...........-............................... - Number of living units:-.-."J... Number of bedrooms :3:....__Garbage Grinder YeS".... Lot Size ....acre ..................... i Water Supply: Public System and name ...................................... .............................................:...........................Private z Character of soil to a depth of 3 feet: Sand❑ .Silt❑ Clay ❑ ' Peat❑ Sandy Loam ❑ Clay Loam ❑ { Hardpan ❑ Adobe [3� Fill Material ..A9.... If yes, type --------------------------- yy. 1 (Plot plan, showing size of lot, location of. system in relation to wells, buildings, etc. must be placed on reverse side.] NEW INSTALWTION: . (No septic tank or seepage pit permitted if public sewer is available within 200 feet, PACKAGE TREATMENT { } SEPTIC TANK T ] Size...........:...........7............... ........ Liquid Depth .............. ........... .. Capacity .................... Type .................... Material.--•-•---.-_-----_ No. Compartments ...................... Distance to nearest: Well ....................................Foundation ...................... Prop. Line LEACHING LINE ( ] i—No: of Lines"I...........".- .. g g _ ....... Length of each line..-"------ ---------"...---- Total Length ......--•...•- ............. D' Box ------_-I_-- Type Filter Material .................1--Depth iFilter Material ------------• I ...... ..... ,................... Distance to nearest: Well .. Foundation "- :__-.._-_-.__ Property Line SEEPAGE PIT [ ] Depth .................... Diameter ................ Number ............................. Rock Filled Yes ❑ No 010 • Water Table Depth .........Rock Size s Distance to nearest: Well....................... .Foundation Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# .....4..................._.r..:_"___------- .Date ..................'................] Septic Tank (Specify Requirements( -----------............................................................................... ........ ------------- ....... :.................. . Disposal Field (Specify Requirements) -•-•--••..............."=d...10,0.1- OT'-'le-wc—i---1•lrie' 'to'"existin-"... §Y. 'tem" ----------------------------------------------------------- .............................................................-.".................................."....------ ........ ......................."...._..............._ ..................... (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 Reguiations of the San Joaquin Local Health District. Home owner or liven- sett 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 become subject to Workman's Com ensation laws of California." � Signed ...--..."" ............ ... .............. ..... ' .... Owner'Contractor By ............................ .. . ........ .. ... ........----•......... Title - ------.....,...:...,..................................... ""...... (If a e hon owner) FOR DEPARTMET USE ONLY APPLICATION A EPTED BY ..... ..� ...... .. .:. ... ............................................... DATE .3:..Z_�:�,..�_...._a....... f BUILDING PERMIT ISSUED .............:....................��.. .-•--.:.......:..............:...... DATE ............. ADDITIONALCOMMENTS .................. ............................................ ---.........------------ ----.....-.... •-•--•-•-.. ........ ; ---------------------------------------------•------------- -••----•------•------- -•-------- --..--.-..................................-----....._-------------.-------. .--•- JJam�'' ..... ..�......�.... ......................................w+•yJ ."........... ............................... ........ ( J I Final Inspection by ......Dot .....__ . ................. SAN JOAQUIN LOCAL HEALTH rDISTRICT F_ w- 13 24 1.'A;1 Rwv_ 5M 7/72 3 M -