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FOR OFFICE USE: <br /> PPLICATION-FOR SANITATION PERMIT <br /> 93 <br /> ------------------------------------------------------ ! <br /> - Permit Nos-- -- ---- <br /> (Complete-in Triplicate)— <br /> ------------------------------------------------I--------- This Permit Expires I Year From Date Issued Date Issued I <br /> Application is hereby made to the Son 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, N00549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ---------------- ---------- ---------------------�Y----- -- '-CENSUS TRACT 'S' <br /> - ----------------------- <br /> Owner's Name -----Steve—Salfar ---Phone ------------------------------------ <br /> -----------------7---f-------------------------- <br /> Address -------------Same----------------I------------------------------- --------------------------- Cit- ...... <br /> - ----------------------- -------------------------------------------- <br /> Contractor's NameB1aQkar_d_'_s---S_eP_t!_r,__Ta1nk4_ �_,__----------------------License # ___2.x$_9.51_____ Phone ....46_3L.?!_70.4_8--- <br /> i�' -CA <br /> Installation will serve. Residence ff]Apartment House.,E] Commercial :E]Traller Court [3 <br /> Motel 7 Other --------------- --------------------------- Jr <br /> - <br /> Num-ber of living units:._.____._- Number of bedrooms ----___?__Garbage Grinder ------------ Lot Size ----------40---Aares........ <br /> Water Supply. Public System and name ----------------------------------------------------------------------------------------------------- ---Private E] <br /> Character of soil to a depth of 3 feet.. Sand'[:] Silt F <br /> Cloy D Peat E] Sandy LoamT] (;Iciy Loam.E:1 <br /> Hardpan E] Adobe [:] Fill Material ------------ If yes, type ---------------------------- <br /> (P[ot'plan, showing size of.lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.), <br /> A I . <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> 6 <br /> .PACKAGE TREATMENT SEPTIC TANK', Size-__-_-_- ---5-" 4,1 o,, Liquid Depth ---- <br /> ---------- ------- 0 <br /> 12 0 C <br /> Capacity ..... . -0--- Type ------:5-q.......... Material 0., ompartments --- <br /> , ' <br /> Distance to nearest: Well -5.0-1----------------------------Found6"t'iosn ---------- Prop. Line ___---_0p <br /> It . Y--------- <br /> LEACHING LINE No. of Lines --------- -------------- Length o-f"each linb, Total Length 100" <br /> -------- . ...... -------- <br /> /--------------I---------- . .. . <br /> 'D' Box ----I------ Type'Filte_mareaal__2. .........D e"t h 'F i I r�b-l-t-e r i a I _--------1 91-- - ----- <br /> � 4 <br /> � � .WI <br /> - <br /> Distance to nearest: Well --- -�6_0p�pdation -2.a� - ProDertv Line - g <br /> EEP4GE PIT Depth --------?�'----- Diameter A�_"-------- Number -------- ---------------- Rock Filled Yes = los <br /> Water Table Depth ----------------9-0---------------------------Rock Size ----------2..................... <br /> 100 ' 1002 to <br /> Distance to nearest. Well -------------------------------------Foundation -------------------- Prop. Line ----- .:0 <br /> • REPAIR/ADDITION(Prev. Sanitation Permit -------- ----------------------------------- Date ----------------------------------1 <br /> Septic Tank (Specify t - <br /> Requirements) -----------120-0---gal----------------------- -----------------I--------------------- ------------------------------ <br /> ----- ------------------- ------ <br /> Disposal Field (Specify Requirements) -------1-0-0�!......Leaeh--Line--- '(1)----p 1 - -'-36"X 28' <br /> ---------------------------------- ------------------------------------------------------------ - - ------------------------------- ----------I----------- <br /> ---------------- ------------------------------------------ ------ -------------------------------- ------------ ------------------- --------- --------------------------------z--------------------- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accorclarice with 56n Joilquen <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health Distrikt. Home owner or licen- <br /> sed agents signature certifies'the following: <br /> "I certify that in the perf-dwrman'ce of the work for which this permit isissued, I shall not employ any person in such manner, <br /> as to become subject to Workmdh.'s,Compensation lows.of California." <br /> Signed <br /> - ------------------ ner. <br /> By --- ---------------- ------ - ------!_ -------A� COntra'-ctor <br /> ------------------------ Title -.1------------ ------ -------- -- ---------------------------- <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY; <br /> APPLICATION ACCEPTED'BY'... ------ ---------------------------------------- ,e 7-------------- DATE -7 ---------- <br /> BUILbiNG PERMIT ISSUED ........ ------------------------------------------------------------ `------------DATE _..------------------------------- ------ <br /> ADDITIONALCOMMENTS ----------------------------------------------------------------------------------- ---------------------------------------------------•------------------ <br /> I---------------;; -- <br /> ------------:---------------------------------------------------------------------------- E <br /> y-------------------------------------------------------- <br /> ------------------------- ------------------ -- ---------------------------------------------- --------------------------- ------------------------- ----------1------------------- <br /> ------ ------ ----­­--------------------O-Z---------------I - ----------------- ---------------------------------------------------- -----------I------ <br /> FinalInspection by.. --------------- ------------------------------------- ---------- Date ------------- --- --- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'6$ Rev. 5M 1%L <br />