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FOR OFFICE USE7 <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) <br /> --------------------------------- <br /> From Date Issued Date Issued --- <br /> Appli-tit'i-on 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 /> Number of living units:---- ----- Number of bedrooms ----/---...Garbage Grinder ---- Lof�§ize Adc,a�6- ------- <br /> CharocItIr of soil to Al epth of-3 feet; Sand I-] Silt E] ClayjEl "Peat Ej Sandy Loa�; -E], Clay-Loom [�J� <br /> (Plot plan, showing size of lot, location of systeml in relation ta wdlls, buildings, etc.��must be placed ori reverse side.) <br /> NEW INSTALLATION: (No septic ton, pit permitted if public sewer is availabl6'within 200 feet) <br /> Capacity _IXOP----- Type1?AF__FAJ5_j Mcit6� ricil �No. Compartments' --'-'Z--—-------- <br /> 'D' Boxm�----Type FilteriMaterial Depth Filter Mat9rial - ----- --------- <br /> ------------- <br /> SEEPAGE PIT Depth ----- Diame ter f__f_,%__..94�Num -- ---- --------- R f <br /> Septic Tank JSpecify Requirements) ----- ---------- <br /> I hereby certify thifft I hav prepared this application and that I the work, w-ill'bi done in accordance-with Son Joaquin <br /> County Ordinonces#AtateAaws, ci�c�Rules and Regulations of th6,1, c�n oaquift Local Health-Vistrict. Rome ownfer�or licen- <br /> sed agents signature certifiJs the following: <br /> "I certify that in the perhir-mance of the work for which this perr6it is !$sued, I shall not empl'oy;. Ly pLon in ibch manner <br /> as to become blect to Work an s Compensation laws of Califorri,i;e� <br /> 711� -------------------- <br /> Signed ----V" <br /> (If other than owner) <br /> FOR 0EPA-RTMENt USE ONLY <br /> APPLICATION ACCEPTED BY _____rj_k-a <br /> ------------ <br /> . � <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. P l''68Rev. 5AA <br /> � <br /> . / <br />