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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT , --- - ------------------------------------------------- (Complete in Triplicate) Permit No --------- -------- 40 ____________ This Permit Expires 1 Year From Date Issued Date Issued,,:!V 1::/ 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: . W y � JOB ADDRESS/LOCATION Z_266±+3__ 0.___Ba-nta goad=____ a_cy______ '0 C SUS TRACT-----_____-__.______._ Owner's Name --------- ----------------------------- ----------------------------- ------------Phone _63-5-4849------------- Address Same-= --HQAS_e---sough --of--tra_i lex---b_OUSe------------- City -----Trac-Y--------------------------------------------------------- Contractor's Name -----PA±NVIST_-PLUt BING--.`'sUVICE--__________.License # _9959'_ --------- Phone ----83.5-1114----- Installation will serve: Residence M Apartment House,❑ Commercial ❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number of living units:--- ------_ Number of bedrooms -----Z----Garbage Grinder ------------ Lot Size __--A cerage_____________________ Water Supply: Public System and name ----------------------------------------------------- ---------------- ---------------------------------------Private Ec Character of soil to a depth of 3 feet: Sand"El Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe [fill Material ------------ If yes, type __________________________ Q (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,) PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size-----------------------------------_------------ Liquid Depth -------------------------- 6N Capacity - ------ --------- Type ------------------- Material--------------------- No. Compartments --------- ------------ W Distance to nearest: Well _-________________________-___Foundation ---------------------- Prop. Line ...................... LEACHING LINE [ ] No. of Lines ------------------------ Length of each line--------------------- ------ Total Length __________._____--___--.__ 'D' Box ------------ Type Filter Material ______-____-_--_Depth Filter Material ____________________________________________ Distance to nearest: Well ------------------------ Foundation -----_----- _----_---:_- Property Line ------------_-- ...... SEEPAGE PIT [ J Depth -------------------- Diameter ________________ Number,`______________________ Rock Filled Yes ❑ No i❑ Wafter Table Depth ------------------------------------------------Rock Size ------ ----- -- D stance to nearest: Well _________ _ ___ ____ ________________Foundation -------------------- Prop. Line _______--___..._-..__ REPAIR/ADDITION(Prev. Sanitation,Permit#-------------------_------------------------- Date ______________________.___-_______) Septic Tank (Specify Requirempnts) `----___ _____Exist_ing-------------- Disposal Field (Specify Requirements) ______.-i1S-tallimg---`7-5---1IT3--ft,-_X-2- .u__-Wide_Suppleme_ntary__-_. -----leaching---drain--------------l--D---fox--- --------- ---------------------------------------------------- --------------------------------------------------------------------------------------- ----- --------------------------------------- (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application"tend 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 perf ce of the work for which this permit is issued, 1 shall not employ any,person in such manner as to become subject to ork an's Compen laws of California." Signed _ PA-L+YIQUIST PLU P SE DICE -- ---- - -- --- - ----- ,�, L-c By -- --------------------------- (if -- - - Title --�IaI13ger (If other tha owner) F R DEPARTMENT S ONLY, - - - DATE _AP o4l-----�� ( --------- APPLICATION ACCEPTED BY _ - _ _-- _____ __________ 7 BUILDING PERMIT ISSUED --------------------------------------------- ---- -- ---- ------ -- ----- ----------------------DATE ADDITIONALCOMMENTS -------------------------------- -------- ------- ----------------------------------------------------------------------- - ----------------------------------------------- --- --- --- - -- - -- -----------------Final Inspection by: - -- -- -- -- �y a` � -- Date . /!- ,. ;i- .T SAN JOAQUIN L AL HE L (D RICT E. H. 9 1-'68 Rev. 5M.