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FOR OFFICE USE: lv (I La '�;i�.C... q2- t APPLICATION FOR SANITATION PERMIT ----------------------------------- CY ssy (Complete in Triplicate) Permit No. ___"____----------- --------------------------- __ _______ - --------------------------- ---------- Gp _________________________________________________________ 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: Tr acy JOB ADDRESS/LOCATION ____-Site 2N19 Lakeside Drive :S.J.River C1t-&NSUS TRACT _______________-------__- Owner's Name ------T'---w*---Knuts--------------------------------------------------------- -------- -----= -------------------Phone---------------------------- Address ---575._BaYviews---- unnyside,_ kali#'----_-----------_--- City ---------Sunny-a id_e,_C_a1_if---------------------------- Contractor's Name _____PALMQUIST PLUMBING SVC , License # _0689------------ phone ----fl3.5-_3114..... Installation will serve: Residence EMpartment House❑ Commercial [-]Trailer Court ❑ Motel ❑Other --------------------------------- ---------- Number of living units:--- ------- Number of bedrooms _- .......Garbage Grinder _NO______ Lot Size __501- X100 Community Private Water Supply: Public System and name ---------- --------------------- ---- --- ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay '❑ Peat❑ Sandy Loam ❑ Clay Loam;❑ Hardpan ❑ Adobe XX Fill_Matehal'------------- 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 [XX SEPTIC TANK,[ ] Size----- ----6_3 Liquid Depth _._56.._....._.._,_____ Capacity ___1200____,__ TypePXe--0_a3t_ Material-OblaCT'et_e_ No. Compartments -----2..........:.... Distance to nearest: Well -------30Q!-------------------Foundation __15-t------------. Prop. Line ....10'........... LEACHING LINE [ No. of Lines -2-------------------- Length of each line---90-1------------------ Total Length 90_t__.XZX.X10.tx4 'D' Box ----- Type Filter Material _-Se.tic_.*th Filter Material ____19_"............................... Distance to nearest: Well -------------------------Foundation .----------------------- Property Line ----------------------- SEEPAGE PIT [ Depth -------------------- Diameter ________________ Number ---------------------------- Rock Filled Yes ❑ No i❑ d Water Table Depth -------------------------------------Rock Size -------------------------------- Distance to nearest: Well ________________________________________Foundation -------------------- Prop. Line ...................... r REPAIR/ADDITION(Prev. Sanitation Permit# -----------------_----------------------------- Date ____-___--------_---___-______--- ) a SepticTank (Specify Requirements) -------- -----------------------------=----------------------------------•--------•-----------------------•----.,_--------------------------- Disposal Field (Specify Requirements) --------------------------------------------------------------------------------------------------------------------- --------------- ------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------- (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, 1 shall not employ any person in such manner as to become subject to Workman's pI sati�on law of alifornia." Signed ___PALMQU_1ST---P_LUMBZ_ ,G--- R ICE- -------------------- �xX By --------------- ------------------ �_ Title -------NTanager---------------------------------------------- ------------------------ ------------ ------ (If other than owner) FOR DE TMENT ONP n APPLICATION ACCEPTED BY --------------------------------------- --- L------ DATE ___ ' I ----------- BUILDING PERMIT ISSUED ----------------------- ------- ------ -----DATE -------------------------- ADDITIONAL COMMENTS ----------------------------------- -------- ------------------- ------------=-------- ------------ ------------------------------------- -------------------------- --- -- ------- ------ -------------------------------------------------------- -------------------------------------------------------------------------------------------- - ------------------------------------------------------------- ------ ----- - ------ �q Final Inspection by: ----------------- ------------------------------------- ' --- ----------Date .--- - SAN JOA IN CAL H I RICT E. H. 9 1-'68 Rev. 5M 9 � �� 6 36"