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FOR OFFICE USE: <br /> APPLICATION POR SANITATION PERMIT <br /> !Complete In Triplicate) Permit No. ................. <br /> Dote Issued ../.` <br /> _..._.............................. .------. . , This Permit Expires 1 Year From Date Issued <br /> __72 <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County'Ordinance No. 549,and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION <br /> ---242•28--1V©-.--•P£AR•L:........................................._..................,......CENSUS TRACT ..................... <br /> Owner's Name -..DAVID-GIFFORD-------------------- 1 <br /> Addressf <br /> . City ................. -::..........._.......................................... <br /> . <br /> Contractor's Name ._CAL..IIIES.T.ERN_:SANV�TA11Q111. ........L€cense # _1817�3�.... Phone 99I-1039 <br /> installation will serve: Residence ®Apartment House] Commercial OTrailer�Court 0 <br /> Motel Q Other .. <br /> Number of living units:_..•1:_.: Number of bedrooms Garbage .. <br /> _ - <br /> Grinder'... .... '`Lot Size ..4..996 ACRES <br /> Water Supply: Public System and name ` 4 f ( I ; I <br /> Pp Y -..._..........................---Sa....... <br /> if . I I •......................Private <br /> Character of soil ton depth of 3 feet: Sand Silt Clay-[j Peat❑ dy Loam Ctay Loom [$ <br /> .. <br /> i Hardpan [] Adobe o `Fill Matil <br /> era <br /> E lf'yes <br /> lei type •�--.-•• •......... <br /> (Piot plan, s#�owing size of�iot,dlocation of system in relation to wells buildings! etc. :mu•st be laced-on_reverse"sidia.) <br /> NEW INSTALLATION'_ (No septic tank or seepage'pit-.0irmitfed if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK I ] _ Size..-:._1AG9-a=A...............:.'" ..... Liquid Depth ............. f <br /> ............. <br /> Ir Capacity r �_ :,.XTYpe.••---•-----------_,Material..Q0PJCRIITE. No. Compartments .._2--•............ <br /> Distance to nearest: Well .............. _.Foundation <br /> � ----••---••-----'�-- ...................... Prop. Line ........... ........ <br /> ' LEACHING LINE � ` wf S <br /> [ ] No. of Lines _._._3----------------- Length of each line....... ........... Total Length .......13x............ <br /> 1J <br /> Box JE-5... Type Filter Material -10ASHEI]Depth Filter Material ...................... l <br /> ...................0 <br /> Distance to nearest: Well ..1QQ�a............ Foundation .. <br /> - 1.D_.+.----..... Property Line ......Sp.:.#...... <br /> ...z <br /> SEEPAGE PIT [ ) Depth ...... ---...... Diameter ------3f!!--- Number ....3...................... Rock Filled Yes [3 No O , <br /> Water Table Depth ---••--------------•35'- ...................Rock Size .....3.n...ttaV........... � <br /> / Distance to nearest: Well ------•------------•------ ----------Foundation .............. Prop. Line ......................P <br /> REPAIR ADDITION(Prev. Sanitation Permit# _..:......._---.__------- ) 1 <br /> --------•-----...._ date ...--•-•-•-------...----••-------• <br /> Septic Tank (Specify Requirements) ................. ... .. <br /> Disposal Field (Specify Req.uirementsl _____________ <br /> •----------I------------- ------------------­---------- ------------...----------- ----------•------------.-----------------------------.......... ..................... ................. <br /> ----------.--------------- -------------I­---------------- --------------------------------------------­­........................................ <br /> (Draw <br /> --- - <br /> (Draw existing and required addition on reverse side) <br /> hereby certify that,.!.have.prepared.this application and that,the„work.,will-be done in accordance.witlt San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health,Distric- No owner or liien- <br /> sed agents signature certifies the following:. t <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person lei such manner <br /> as to become subject to Workman's Compensation laws of California.” CAL WESTERN SANITATION ; <br /> Signed --Cal---We$tiWn--Semi.ta-tion../DBA..-WaJ.- HARRIS- Owner 6135 RIO LINDA BLVD. TO.F',,ay 34d <br /> BY lif er than owner) <br /> . --- - 7 .RIO-LINDA, CALIFORNIA 95673 <br /> .Kt - <br /> I - Titl� e - f.— RIO-LINDA CALIFORNIA-------•------ <br /> , <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- ` ---------- - ------ --• - -----------._ . DATE .1,1__'. z.j- - <br /> ----------------- <br /> BUILDING PERMIT !SSU! D - DATE ..-.... <br /> ---_-------_-- <br /> ADDITIONAL COMMENTS ------ .................... <br /> --••-_--- <br /> ---••-----•----------------••- --------......_ <br /> -------- -------- --- -------- ................................. <br /> --------------------------------------------------------•-- ----- <br /> Final Inspection b --------------D . . <br /> 1-Y- ate ....�."? <br /> EH 13 2!t I-68 Rev• 5� SAN JOAQUIN LOCAL HEALTH DISTRICT � <br /> $/74 3M ' <br />