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FOR OFFICE USE: �L1 CATIION FOR S A7I Mir / 3 ------------ (Complete in Triplicate) ? Permit No: '�__ .. . Z5"( !0 -05 ______________ This Permit Expires I Year 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 des;-ribed. This application is made in compliance with County Ordinance No. 549 and existing Rule and Re ulations: JOB ADDRESS/LOCATION ._-S_�0__Corrall AOIloW Rd.- W. of C'it•y Dump TRK:CY TE T SITZ -------- Owner's TRACT Owner's Name ----P�7yS1C-s_-.I>`1'�e�'I?�t�oi�alG_t�-.---------------------- ------------- ----------- - -----Phone ---------•-------------•- ----------- Address 2 ©© 1�erCed_ t ----------- Cit S__OO Y a a --r---- -- a1if. 9l+ 7 ------ Contractor's Name ---PALMQUIST---PLUMI Q.-SVC_1------------- ----------.License # ._9.991+--------- Phone -83532A....... Installation will serve: Residence ❑"Apartment House Commercial:❑Trailer Court ',❑ Motet 0 Other ---R ' est- ----roo-W--for test site -- ---- ----------' Number of living units_____________ Number of•bedraoms ------------Garbage Grinder ------------ Lot Size XlCBPaj;ie --- ----------------------•-•- Water Supply: Public System and name ---------I----------------------------------------------------------------------------------------------------Private E Character of soil to a depth of 3 feet: Sarrd%❑ Silt p Clay F1Peat EJ Sandy Loam Clay,Loam:❑ 1 Hardpan [] Adobe = ill Material ------------ If yes, type ---------------------------- (Plot plan, showing size of lot, location sof 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,) PACKAGE TREATMENT [ ] SEPTIC TANK Size--- �gSZ}tt 91 ,------ ------------ Liquid Depth ------ 1fg.............. Capacity .12.40-bA;1V,pe __PT9�-0as# aterial__GQnqrete No. Compartments ------______________• Q Distance to nearest: Well --------1 f-5A --------------Foundation --------a.�!------- Prop. Line LEACHING LINE [)tX- No."of Lines --i-1_..____-__ ----- Length of each line------80.T______-_------ Total Length Bot 'D' Box -------------I Type Filter Material S-e-P- io--�pth Filter Material _______J,9�__..__ ) ----------------- ( Distance to nearest: Well 185 ----------- Foundation -------l91________- Property Line ---------20 SEEPAGE PIT [ ] Depth .------------1:-- Diameter _______________ Number -------------}--------_----- Rock Filled Yes ❑ No Water Table Depth ---------------- --------------------- Rock Sizes-',i _ ----- C i �' Distance to nearest: Well -----{--------------------------------Foundation -------------- ---- Prop. Line -_-----------------_-- REPAIR/ADDITION(Prev. Sanitation Permit# ____.`.____;----------------------------- Date _______________________ ) r Septic Tank (Specify Requirements) -----------------— Field (Specify Requirements)!------------------- 'i ----- - --------------------------------------------- E --- ------------------------- -- . (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. Home owner or licen. 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 become subject to Workman's Compensation aws f P o California."Cahforn�a Signed ---P4 QUIST PLUMBING SERVI BY --- -- -- ---- -------------------------------------- --------------------- Title . -•- Anager � (If other than owner) ------ FOR .DEPARTMENT USE APPLICATION ACCEPTED BY -------------- !� ---------- --------- ------ ----------- SATE BUILDING PERMIT PERMIT ISSUED --------------------------------------------- ATE ADDITIONAL COMMENTS __.________ ------ D__-_-__ �_ _ •� ________________________________________________________________________________________________________________ _ ___ _ _ _____ __. _____-_____ ______________ -_ ___ _ ________-____ Final Ins ection b ---- ------------- p Y Dat { SAN JOAQUIN LOC L LTH D CT s. E. H. 9 1-'b8 Rev. 5M. x