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FOR OFFICE USE- <br /> r o APPLICATION FOR SANITATION.PERMIT <br /> (Complete In Triplicate) Permit No. <br /> .........................­......... <br /> .......................... :-------- ----- This Permit Expires I Year From Date Issued Date Issued <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 mode in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION 6599---E.----F_o- ��Ro <br /> N <br /> - p ........ ----------------------­........ ..............I........... <br /> Owner's <br /> Name ..'Harr3y-14.alsaaa------------.................. .... ;---------_------------_......... ... ... Phone_9311!t3036-----........ <br /> Address .---•--Sams----------------_.................................... ............................. City ..S-tkni.--------........................_...--•-------•---........... <br /> Contractor's Name.... S..S qpt!q <br /> Tank---------................License# _.-268951_-___. Phone ...463!t.7.045...... <br /> Installation will serve: Ro'sidence Z]Apartment House 0 Commercial OTrailer Court C] <br /> *% {' Motel F-1 Other ._. - - --­_ "' ------------------ <br /> Number of living-un-its.J... .. Number of bedrooms .....1.....Garbage Grinder ---- Lot Size ....5..&,.re4..................... <br /> Water Supply: Public System ond`name ..................... -------------.............................................................-------....Private g] <br /> Character of soil to a depth of 3 feet:' Sana 0 Siltb Clay ❑ Peat E] Sandy Loom C] Clay Loom ❑ <br /> 4 <br /> Hardpan❑ Adobe F] Fill Material ------------If yes,type...... ..................... <br /> (Plot plan, showing, size of,lot, location of system in",relation to wells, buildings, etc. must be placed on reverse side.) 6\ <br /> NEW INSTALLATION: (No septic tank or seepage pit,permitted if public sewer is available within 200 feet,} (AI <br /> PACKAGE TREATMENT J.3 SEPTIC TANK frl il Size......41 41.X5.'.X10._'................... to <br /> I I ................. - Liquid Depth .......... <br /> Capacity -------- Type ...A s9_,... Materlol..qqnArptP No. Compartments ...2..... <br /> Distance to nearest: Well 120.0... . ..............Foundation .. 30!:.......... Prop. Line.........1-0-0!•... <br /> LEACHING LINE k] No. of Lines ...I................... Length of each Iine..1()().1o................. Total Length -___1{00:,x_............. <br /> V Box ....3:...... Typp Filter M;terial ....?..............Depth Filter Material ............19........................... <br /> Distance to*nearest: Well _20V.......... Foundation ----_------ Property Line. J.OoL!.............. <br /> SEEPAGE PIT bd Depth ..... .. 36 <br /> .... Diameter................. Number ............................ Rock Filled Yes fn No C3 <br /> Water Table Depth _9Q ....................Rock Size _._._.....211....__......__.._ <br /> Distance to nearest: Well t.–.-2j0CL1....................Foundation ...........10.0.1 Prop. Line ........1. QX...... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ....... ...... .................. ........ Date .......... ................... <br /> Septic Tank (Specify Requirements) .............. ..`Tank........... .,........- ....._...................... ....... <br /> Disposal Field (Specify Requirements) .__...10-0_!__.Le"h_L1ne__&...361,xz5-! P-1-t-------------------------------------------------- <br /> ..................... ---- -- ................ ------------------ ...........................................................................­­.................... <br /> .......................... ........... ....................----------­-­.................­­........................................................................................... <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 accordance with Son Joaquin <br /> County Ordinances, State Laws,-and Rules and Regulations of the Son Joaquin Local Health District. Home owner or [icon- °,'I <br /> sed agents signature certifies the following; <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 law;ef California." <br /> Signed----------- -------*------------- <br /> .. <br /> . .. .... ........"............_:............... Owner <br /> - -- <br /> BY ......................... Title ................... <br /> Ilf other than owner) <br /> ---FOR DEPARTMENT USE ONLY <br /> -7— <br /> APPLICATION ACCEPTED By ..-- –CW.. <br /> ....224�___, ._ .......................... DATE .... ... ...... <br /> ---------------- of $�/ <br /> BUILDING.PERMIT ISSUED .- - - ­ .................. ---------------------;..................................DATE .... .................. ........... <br /> ADDITIONALCOMMENTS .......................__-------- ------ ---- ------------------- - ---- -*------ ----- ----------- -- . .......*................ <br /> ........... ..............I........... ------------------------------------ <br /> ............. -------- ------------------------------------------------------­......... ----------- ....... <br /> ..................................------- ----------- ----.--.-.------------------------.-.-.----------------*------- <br /> --_-_------------------------------------- <br /> ­----------------- ..... ..._...... <br /> .. <br /> f4.. <br /> Final Inspection by. ..1 ,........ ------ ------- .......Date ...ac. --------- <br /> SAN 'JOAQUIN LO AL HEALTH DISTRICT <br /> E. H. 9 1 Rev. 5A <br />