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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - (Complete in Triplicate) Permit No. _ , <- -- A ______________________________--_____________-_ This Permit Expires 1 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 described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .---26.975 -Banta Road.------- Tracy----------------------------------CENSUS TRACT ----------------_-------- Owner's Name - - -RO E!r--$e)ltI - Phone -835 !7-7;0i----- -------- Address .... .........................269_-7.8__-Baclta---goad-- ---- --------- City -- TracY---------------------------------------------------------- Contractor's Name -- PALMQUIST___PLUMBING SVC_. License # __99594 ---_ ____ Phone ___-835!!-7;M Installation will serve: ResidenceXX Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other ------- ------------------------- Number of living units:------- Number of bedrooms ----3_-----Garbage Grinder ------------ Lot Size ____ACerage - - - ------------------ Water Supply: Public System and name ----------------- -----------------------------------------------------------------------------------------PrivateXX Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam OX Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type ----------.-------.----____- , (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 ___-_-_---______._____- Capacity ------------------- Type ------ ----------- Material------------------ --- No. Compartments ------ ............... 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 [ ] Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No i❑ Water Table Depth ----------------------------------------------Rock Size ------------------------------- Distance to nearest: Well _________________________________--_-_Foundation -------------------- Prop. Line _---___-_____-_-_. -. REPAIR/ADDITION(Prev. Sanitation Permit# _______________(.1�`-_-_____-___ Date ____--_1963-_________-____-) Septic Tank (Specify Requirements) -------------E$!EX!-q-t!;qg----------------------------------------- ------------------------------ Disposal Field (Specify Requirements) --------- 100_ lilt -ft . 2---_ ft._-w_id.e; 1 D-iver R s_ion ox----------- uppleme rtary t o existing 200 ft. -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------.._ (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 laws of California." Signed -_PALMQUIST- PLUM_ ING SERVICE! B "_. r - Title ana, er - ----------- Y - (If other than owner) --- FOR DEPARTMENT U E ONLY, APPLICATION ACCEPTED BY -_-_ -__-_ _____ ---------- . DATE �' - --------- ------------ BUILDING PERMIT ISSUED _- ----------------------------------------------- ------------ _c -----------------DATE ------------- -__ - .ADDITIONAL COMMENTS ---------------------------------------------------Z_ ______.- --------- -- ---- -- -- ---- ---- -- - ---- -- --- ---- ---- -- --- --- - - - -- -- ---- -- --- ------ --- ---- --- ---- --- --- ,- -- -- _ Final Inspection by: ----------------------------------------------------------------------------------------- ------- Date -- = 1 ' SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6(3 Rev. 5M