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. F��OFF <br />~ ^ '� .CE USE. <br />APPLICATION FOR SANITATION PERMIT <br />` <br />(CompleteTriplicate) <br />This Perm"Wiiix- <br />. ' <br />po,mh No. <br />Date \soon6 <br />Application is he..~ tothe Son Joaquin Local Health District for o~—'— it <br />to ~~'st,v^c^ and |nmoU the work here|ndeycribe6. This application is made in compliance |[.n�y�|9 oiR 6 Regulations: <br />JOB ADDRESS/LOCATION _. r <br />---------------------------------- <br />Contractor's Name ----- A <br />Installation will serve.. Residence D!f Apartment House,F - 'trailer Court :F <br />] Commercial 1:1 <br />Character of soil to a depth of 3 feet. Sand'D Silt 0 Clay D. Peat El Sandy Loom -F] Clay Loom <br />Hardpan Adobe F�ill Material <br />(Plot plan, showing size of lot, location of system in relatip- n to wells, buil8ings, ef�. must be' placed on reverse side.) <br />NEW INSTALLATION: (No septic tank or seepage pit permitted if. public sewer is available within 200 feetJ <br />Capacity 11 <br />Septic Tank (Specify Requirementsi ---- 1 ------ ------ <br />Disposal Field (Specify Re <br />(Draw existing and required addition on reverse side) <br />I hereby certify that I have prepared this application and t"t'the work 'Will be done in accordance with San Joaquin <br />County Ordinances, State Laws, and Rules and Regulations of the Scin '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 issui;d,'l shall not employ any person in such manner <br />as to become subject to Workman's Compensation laws of California." <br />Signed <br />_____ <br />— — By _v_.. _._--.—' Owner <br />— &�--- '7hle <br />'—=------------------------------------------ <br />(if other 71 an ----'----'---(|futherF6on <br />(I I FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED 13Y. <br />--------- �7�49MW -------- ---- --- <br />� Y <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />E. H. 9 l''68Rev. 5N\ <br />