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_irPOCIATION FOR SANITATION PERMIT <br /> Permit No. .. <br /> lComplete In Triplicate) <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 /Po �al <br /> Contractor's Name <br /> Installotion will serve: Residence Xx partment House C] Commercial OTraller Court 0 <br /> Number of -rind <br /> Number of living units:---- bedrooms ....Garbage G er - - ------ Lot Size <br /> Character of soil too depth of 3 feet: Sando SiltE] Clay .[-] Peato SandyLoamC] ClayLoamw <br /> (Plot plan, showing size -of lot, location of system in reflation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: JNo septic tAhk or seepage pit permitted if public sewer is available within 200 feet,l <br /> PACKAGE TREATMENT SEPTIC TANK I Size. 1-�ve <br /> IN <br /> Capacity /------­----- Type _Materiaeume&:�71C_240.Z Compartments <br /> Distance to nearest: Well ..... .... ion ------ Property LlndA, 1.4 <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 wit h Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or licen- <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 s uch manner <br /> as to become subject to Workman's Compensation laws of California." <br /> lif other than ownerl� <br /> FOR DEPARTMENT USE ONLY <br /> ----- --------------- -------------'`'--'—'--r~---'—'--^-------^'-----'------'---'—'--'-- <br /> ----------.. '------.�-------'—'---_.----. <br /> -------_--.. '------------� ,���` <br /> t. <br /> R"o |n�pnc�on6v .. --- ---------����' �'/�� -- <br /> ' E8 13 ?� l~�� �m�� ' �N ^/ — - - ' <br /> -~ ~ ~'' ' SAN JOAQUIN LOCAL HEALTH DISTRICT 8/r� � <br /> L ' - <br /> [ <br /> �� <br />