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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT a65� .............................•---------..-..-...----...- Permit No. . IComplete in Triplicate} /'...---•--.. ............- -------------------------------7777........, _ � ..._ This Permit Expires 1I Year From Dots Issues! Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County'Ord Inonce No. 549 and existing Rules and Regulations. JOB ADDRESS/LOCATION ....242.28--Wd-.--•P.E.AR4 ....-...---._.................................................:....CENSUS TRACT ........................ i i Owner's Name ...DAUB.D__GIFF13RD.-_...---.__.............. Phone 1-20907..45.nZ19!]. Address ... City Contractor's Name _-Cal...WESTERN_:SANIi:AII0111.................. .•....._......License # .18 784 ...... Phone 9917.1039.......... Installation will serve:: Residence ®Apartment Housef3 Commercial OTraller.Court 0 x Motel ❑Other-------•-•••.............................••- . . Number of living units:...:1..-... Number of bedrooms 4._-Garbage Grinder�..��. `Lot Size ..._4•.••.'396 ACRES Water Supply: Pubt+c System and name .......... .. . ( ' _ } I......................Private.] pP Y= Y ....... - Character of soil to a depth of 3 feet: Sand ] silt{] -Clay Q Peat❑ . Sandy Loom fl Clay loam [� ,.. t 1 Hardpan j] Adobe 0 Fill Material if yes,type plah;sshowing size.of lot; locatlon of system in' relation to wells, buildings; etc.�must be-placed"ori reverse side:1'"` NEW INSTALLATION-1 (No selstic tank or seepage pit jyermifted If public sewer is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANK S#ze:..:.. j.. �r } ( ] ] 16 ::`............:.... f""" Liquid Depth .-:....................... Capacity .:ti--------- TYPe.•-...................Material.0KCRETE.. No. Compartments ; ....Z...............V Distance,to nearest: Well ........... ...................`.'....Foundation ...................... Prop. Line ......................r r r LEACHING LINE [ ] No. of Lines .-___3----------------- Length of each line.-..---45................ Total length ........135.'............ . 'D' Box _-YE.5--- Type Filter Material .' RP�PDe.pth .Filter Material ....................'................... ...� Distance to nearest: Well ..100.�. ............ Foundation -.:..1D.'-+.......... Property Line ......50.1.*......... SEEPAGE PIT [ j Depth ------25--------- Diameter ......3b"_._• Number ----3...................... Rock Filled Yes [3 No 0 , Water Table Depth .......... .........35!.*---..............Rock Size .- 3"..taV......_.... ! 'O �f b } Distance to nearest: Well ........................................Foundation ..................... Prop. line ......................P REPAIR/ADDITION(Prey. Sanitation Permit# .....-..--------------•---------------...... Date .......: ......... SepticTank (Specify Requirements) --.:_-- .........................•--•----........_........._.... •----•--•--•---•••-------•.._._... .'....................... ,.Disposal Field (Specify Requirements! ----------- ----------------------------------------------------- ........................ rf t '-��,•--.....---,.---------------------------------------------------------------•----------------------------'..�--__•---------------------------------------•------•.--_..-................................. (Draw existing and.required addition on reverse side) F ! 1_:hereby certify .that_I have.prepared:this.application-and-that fhe,work,will be done in accordance-with lSon_Joaquin y County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health.Disfricf. Home owner of Ilcan=� sed agents signature certifies the following: ' "1 certify that in the performance of the work For which this permit is Issued, I shell not employ any person lri such manner cis to become subject to Workman's Compensation laws of California." CAL-WESTERN SANjTATION Signed ._Cel--Western--8enLtetioin-./•DBA,.•-W.-J.---HARRIS- Owner 6135 R10 LINDA B>.VD. o-i y o ' �. .. .r RIO-LINDA,r CALIFORNIA 95673 BY .......... --• -•-- .....:....... . TFtle ...Office-... a . ----- -------------7777-- -- ....-. i (If her than owner) . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------.-�--.-67`- ------- ------------ DATE ..�.�.-"..z'g. .2._-..-- •-•------- - --------•-•7777-�......--7777-- 7777 �•- - • ---=-- BUILDING PERMIT ISSUED ---------------- - ----..-.-..------.-DATE ..,..---------.-...._. ................. ------•-••---•77••7 7-••---•7777--•--•-•--•--...--•-----------7777-- •- ADDITIONALCOMMENTS .............. . ....•--••---• --- ---------- ...................I..................................._.....--..-.-- ----_.. --.-•--- --•-----.... ...... final In----.------ -------- --------------- - --- --------------- ---------------- -------------------------------------- :.� ��._...--------------.... 7777- ...-- TM - - - ••-•-------•.Date 1.1. :........•--..s ection b ----......7777-- FH 13 24 1-513 }may• SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M