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r FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT !!!- Permit No. ..��.' 4��a (Complete in Triplicate) -- ------------4 ---------'-----..-.. Date Issued _ __-_-___----________--.------- This Permit Expires 1 Year from Doh 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 __26978.BSLitA__jL di.....'T;1 LST-------- .......... ------CENSUS TRACT ----3--------- - __.. Owner's Name -----------------g0� --$Q -----...___._.. --------------- ---------___Phone 8�r.?-...1 ----------- Address .-- ----' ----'--_----269. 8--H$Atfi-_$08d-- - -- -- City _-T ..........—--------------------_ -------------- Contractor's Name ... PI,UMBII�G_3VC._----------_--..License # __99594 .-.-- phone ---- Installation will serve: ResidencdnApartment HoumQ Commercial❑Trailer Court ❑ Motel ❑Other ♦aerage .. Number of living units:._. .Z.. Number of bedrooms ---3_-_-Garbage Grinder _._-------- W.-_ LatS __.�----•------ ---------... Water Supply: Public System and name .------------ �---- ---------------------------Wwcftlx Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Mr 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 RIMALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT I ] SEPTIC TANK 1 ] Size.-------------___.—.—.............. Liquid Depth ...-- -------—.---- - Capacity ----- ----------- Type .................... Materna ------------------ No. Compartments -------------- Distance to nearest Well ____ ___-Foundation--------------------- Prop. Line...-__............. LEACHING LINE I ] No. of Lines ---------------------- Length of each hire---------.-.------------ Total Length ...------ V _--.---- 'D Box ..-_-..... Type Ther Material --------------------Depth Filter Material ...-------------.------_ —.-•-•-- Distance to nearest: Well -------- Foundation ............._.-.___ Properly line .------�.._ SEEPAGE PIT [ J Depth ------------------- Diameter -----------.-- Number ----------- --- -- -___ - Rock Filled Yes ❑ No Q WaterTable Depth .----------------------..—___...---._.__Rack Sia -.__-------------........... Distance to nearest: WeH _-----..._.—Foundation .-- --- Prop. Line ........ jrAzft% REPAIR/ADDITION(Prev- Sanitation Permit# -------.-----.'P. ----------- Date _ J9---3__—_.___..--I Septic Tank (Specify Requirements) ------------W-AtUg_------.--------------_.............. _----------'------------ --------—............... Disposal Field (Specify Requirements) I�. Dl.. -_2- !_7�d�t___I_DiversiOn HOZ gupplefneotsry to existing 200 ft. _ _ ----------------------- -------------------------- ------------------------ - - ............------------- ---- -------------------- - --.................._.._.- (Draw existing and required addition on reverse side) 1 hereby cerWy that I have prepared this application and that the work will be done in accordance with Son 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 net employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed PAI,MVT&5T PIAMBIAG 8$RVI By --—--- - ' "'-- (if other than owner) FOR DEPARTMINT Y APPLICATION ACCEPTED BY---------------------------------- ---- ---�--- '`T•-----.. DATE ---- --'- -�`--------------- BUILDING PERMIT ISSUED ------------.-'—_----- _-. .--- ._—_..-DATE.--.'..-----..._..___...--'-. ` 'ADDITICMIAL COMMENTS -- - - - - — - ' ---- �/------ -------------- -------------—------------------------ -------------------- ---........—' - -- -- -- - '--- ---... -----.-.-...----...................._ 1--------------- ---------- -- - -. _. ...._ Fnal Inspection by: ----------------_----- -------------------------- --------'-...- -- ,..1f!'t.--- Dale.-, `l. 7`-..... ----- .......... -- SAN JOAQUIN LOCAL HEALTH TRICE E. H. 9 1-'68 Rev. 5M