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FOR--OFFICE- - - -•USE-: ------- APPLICATION FOR SANITATION PERMIT ~ -- - ---- - ----- - (Complete in Triplicate) Permit No: ------------------- This Permit Expires ] Year From Datelssued Date Issued _ �o�-_7d, 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 ------- 1� I -•- f' -h-•--St----------------------------------------------------- ------CENSUS TRACT r aret --••------- Owner's Name ........---a, �'-=----------�a'IdQZ- ----------------------•---- ------------------------------ -------------------Phone .-g3 -7G5 Address --------------------- ------------------ 113--D---St_rEe_t-•----------------------------- ----------------•. City r�T'ac�y ----------------------------------------•----------•-------- Contractor's Name _.__PA NQ_VIST-_-PLUMBING-_,SERVICE_______________License # 9915._94___- -- ---_-- Phone ---$3_5�_'3_1A.-_-- Installation will serve. Residence$]DApartment Hous-60E] Commercial•❑Trailer Court ❑ Motel ❑Otherr"�`_- Number of living units;----1_---- Number of bedrooms _Z___--___Garbage Grinder __11TQ Lot Size -------5Q!_X150-f Water Supp Y Trrac ---------------------- ____ ______ __ _____Private E] IY Public System and name _-__ __ ❑ Silt❑ Clay Character of soil to a depth of 3 feet: Sand' ' y ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type ___________________ --------- { 1PIot-plan, -showing size of•lot,-location-of-system in relation -to wells,-buildings, etc. must be placed on reverse side.) I NEW INSTALLATION., (No septic tank or seepage pit permitted if.public sewer is available within 200 feet,) PACKAGE TREATMENT—[ 1.. SEPTIC TANK [Xr . r Size'5VX } 481, ] -------------j--- Liquid Depth -------- ------ Capacity -12009961.Type Prq?!�_q 3-st-Material_COSI@;L@�_9' No. Compartments -----2----- -------- -1�\ Distance to nearest: Wellr ATOn-- -.............'Foundation=IQI---'------- Prop. Line ---••-6r--------- g 8 LEACHING LINE s�. ( No. of Lines,___.2_____- __ _- Length of each �ine___...0___ -_---_ -- _ Total Length ._-160 " - -------- 'D' Box -------.__-- Type Filter Material aPP•Rk_ De th Filter ` - -- - - --- p Mi ater�al ----�-g---n�--------- �" � t Property Line 6-- .. n- ----- PIT Distance to nearest: Well -- Nor1e` Foundation I - Rock Filled �. t SEEPAGE_ [ ] Depth Diameter Yes ❑ No 0 Water Table Depth -------------- ----------- ------..Rock Size Distance to nearest: Well ----------------------------------------Foundation ------------- Prop. t _... -----__-.- ------------------------) Line --------•-------------REPAIR ADDITIN(Prev. Sanitation Permit#..-------------------------------------------- Datei Septic Tank Specify Requirements[ --------------------RGp-laD_J-1 g defunct_-SySteAl----------------------.- 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, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed -----PALMQyZ,5fi-_PLUXI3IX wv �& -- --- -------- By -------------- - ------ Title --------Man1geX------- ----------- --------- ............- ----- -- - - - - ----- ----- (lf other than owner) FOR D A1tTMENT US ON Y APPLICATION ACCEPTED BY -_ BUILDING PERMIT ISSUED _ -- - - - ------------ DATE _63.W_7�------ ------------------- ADDITIONAL COMMENTS ___---------_-------------------------------------- -------- DATE ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------- -- -------------- FinalInspection by: ------------------------------------------------------------------------------------------- Date _ -.,o - �- -------=------- - -- - ---------- ------ - -- -- - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M