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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Z Permit No. -_-7--- -----•-- "- - (Complete in Triplicate) 6 ---------------- ------------- rw ------�-�-�------- ---- Date Issued --- - °-r-- This Permit Expires 1 Year From Date Issued --- r 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 _7474---E. Collier Rd,-,-_AC_a11>P_o.-Co_lli�eT___Rd..CENSUS TRACT --------------_------------ ' � Dusta.n OakView_ School------------------------------------------- ---------- ------=----- ------------Phone ---------------------------------•-- Owner's Name -------------------- - ' 7474 E. Collier Rd. ------------------------------------------ city -------ACa1Vo---------------- •-----------•---7-- Address •---- -- i Address ___-___.___.___ - ----License # --------->----- ------- Phone -- 3fi•$-"5L(15�..-.-- Contractor's Name ETnie I s___Seprjc---S_ervxcg---------------------- Installation will serve. Residence ❑Apartment House❑ Commercial ❑Trailer Court l❑ Motel ❑Other ------SLh,00.1------------------- - ----------- Nung- Private__ -= Number�of..bedrooms--:_. ..__Garlaage Grind ----------------------------,_- - _.._.__ Lot Size-- s , - ------------ � : Private]g] Water Supply: Public System and name ------------------ ---- -------------------- --------- - --- ------------------------------------••-------- Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loom 'El Hardpan (N Adobe ❑ Fill Material ------------ If Yes,type ---------------------------- i V (Phot plan, showing size of lot, location of system -in relation to wells, buildings, etc. must be placed on reverse side.) tankor p e----------------------------------------- Capacity _____ -- ' able within 200 feet,) NEW INSTALLATION: (No septic TANK seepage pit permitted if public sewer is avail Liquid Depth __________________________ PACKAGE TREATMENT f ] S [ ] Capacity -------------------- Type ------------------------------ Material---------------------- No. Compartments ---------------. - Distance to nearest: Well ----------------------------------- Foundation ---------------------- Prop. Line --------------..-----�,da* k LEACHING LINE [ ] No. of Lines ------------------------ Length of each line----------------------------- Total Length -------------------- ...... ------_Depth Filter Material ------------------------------------•-- 'D' Box ____-____._- Type Filter Material _---__------ Distance to nearest: Well ---_------------------- Foundation _______---- Property Line ------------------------ ------------- -11 SEEPAGE PiT [ ] Depth -------------=------ Diameter ---------------- Number ------------------------- -- Rock Filled Yes ❑ No Q WaterTable Depth --- ----------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ______________________________ __ -------Foundation -------------------- Prop. Line -------- ------ ------ - ----------------- ) REPAIR/ADDITION(Prev. Sanitation Permit# ---------------------- pate - Septic Tank (Specify Requirements) --------v-.---,-.----------------- - ----•------------ ----------------------------- ----------------------------#-- _a an- - s11newPits- ----48 --- X51Cloed_ 1zne---------Dr Disposal Field (Specify Requirements) -- attac e_._ �T ----------------- ------ ---------------- ----- -- 9 (Draw existing and required addition on reverse side) I hereby certify that 1 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 ' the performance of the work for which his-permit is issued, I shall not employ any person in such manner as to beco subiect to Workman's ensation la of California," F Signed - ---- -- •------------- Owner - - - -- - - -- -- -- Su erinten ent ------------- BY - -- - ------------ Title .......... p -------• ------- ----- (If other than owne t FOR DEPARTMENT USE ONLY p APPLICATION ACCEPTED BY -------''�`� - ---------------------- DATE __!J ----------- I BUILDING PERMIT ISSUED - ---- ------------------------- ---DATE ------- ----------------------------------- ADDITIONALCOMMENTS ---------------------------------------------- ----------- ----- - - ---- -- -- --------- --�-- - - �------ --- -------------------------------- ----------------------------i---------- ------------------ --------Date ...... ------------ I Final Inspection b SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M