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.-FOR OFFICE USE: APPLICATION FOR•SANITATIONI PERMIT <br /> 7�/403 <br />.........................................­1. ---- <br /> ---•- (Complete in Triplicate) Permit No. __------------- <br /> ........................................................................ <br /> This Permit Expires 1 Year From Date issued Date Issued ......:......:..... _.. <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 /> „N <br /> JOB ADDRESS/LOCATION . ..,24230...NU._PEARL................................. ...CENSUS TRACT <br /> Owner's Name -LEWIS-. LILLEN._.. '...:. ........................`.......% '..`_-.....Phone . <br /> t.�-L <br /> Address . .....;.--•.......................................................•---......__...... --- --.... City ............:''.... .....................................--------........... <br /> Contractor's Name ----ZAL_W[FSTE.RN•.•SAX1TATI[1N................................License # .181784......... Phone .....9.91mll[139....... <br /> Installation will sere: Residence [2 Apartment House Commercial❑Trailer Court <br /> Motel ❑Other ........................................... <br /> Number of living units:....I------ Number of bedrooms .:.3-------Garbage•Grinder .NQ...... Lot Size ....4..956.-ACRES............. ' <br /> Water Supply: Public System and name .....Private 61 <br /> Chorocter.of soil to a depth of 3 feet: Sand b Silt-0 Clay ❑ Peat❑ Sandy Loam o Clay Loam L2 <br /> Hardpan ❑ Adobe ❑ fill Materiol...._..........If yes;-type,....s -..:...:::.::. <br /> _ - - <br /> (Plot plan, showing size of lot, location.kof;system in relation to wells, buildings, etc. must be placed on reverse side.[ <br /> NEW INSTALLATION:, .w <br /> (No septic tank or,see"p"agepit .permitted if public sewer is available within 200 feet,[ S, <br /> PACKAGE TREATMENT [ ) SEPTIC TANK{ ) Size:....,..12C1q....................----------- Liquid Depth .__ '................... <br /> ... Materiol..G4�GRETE. No. Compartments 2 <br /> .----._..... <br /> Capacity -------------------- Type •---------....--- p ...._.... � <br /> .� Al �.. r. <br /> Distance.to nearest: Well ....................................Foundation .............. Prop. Line ....---- ...........Z <br /> LEACHING'LINE [ ) No. of Lines _.___3.......---------- Length of each line-------45................ Total Length ...._1�5.:............_. . <br /> 'D' Box YES__._. Type Filter Material _ft..WASHEDepth .Filter Material ............................................ <br /> �b <br /> Distance to nearest: Well ......... Foundation -1.Q-_f_------------ Property Line .- . ...t.............; <br /> SEEPAGE PIT [ j Depth ......25--------- Diameter ----3G"----- Number .......3................... Rock Filled Yes (3 No �[]� <br /> _:1 Water Table Depth .35!.+.................. ......Rock Size ...3!' -Atx..15......... <br /> Distance to nearest: Well ........................................Foundation ............_....... Prop. Bine ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ...:........................................ Date .----------------------------------l a <br /> f <br /> SepticTank (Specify Requirements) .................._--------------- ................................-----------------------....._.._........................... <br /> Disposal. Field (Specify Requirementsl ------------------------------------- - - - -- -----------------------------------------------------------------------.. .......... <br /> ------------------------- ------------------------------------- --------------------------------------------_....------------------------------ ---------------------------------------.........------_-- <br /> (Draw existing and required additlon on re = <br /> verse side) <br /> I hereby certify that 1 have prepared this application and that the work will be done In accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Nealth.District. Hone owner or licew ' <br /> sed agents signature certifies the following: is <br /> "I certify that in the performance of.the work for which this permit is Issued I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." CAL-WESTERN SANITATION <br /> Signed --GAL--WESTERN--SANITA- -IQN':/DBA..-__W..A.___HARRIS._ Owner 6135 RIO LINDA BLVD. .-0, i3au 3qe <br /> RIO LINDA CALIFORNIA 95673 <br /> By -...- ---it� --- � ..... ------------------------------------ Title ---•( FICE---MAAGER-..-------------------- - <br /> (I they than owner) <br /> _ FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .......... ' ------ -----. DATE ./�-..Zg.Y •----- <br /> BUILDING PERMIT ISSUED . -------- -------•.................. ...................... ... .......DATE _.........:_..------- ... ----------------- <br /> ADDITIONALCOMMENTS -------- ----- ----- - -------•-------•-------- ------------------ ---------------------------------------------............-_------------ I <br /> -------- - <br /> --- ------------------- --- - ---•------------- --. .. .. -------..............------------- - <br /> .. ----•-- <br /> -------------- ---- f <br /> . ....- ... <br /> ..... .......... ..... .----- -----.::_.. . _. .................., <br /> Z. ..�f <br /> Final Ins ection b Date/1.........5_ ...................._..... <br /> p y. .._.__... . r <br /> EH 13 2h 1-68 itev• 5m SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br /> 4 <br />