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FOR OFFICE USE- <br /> APPLICATION FOR SANITATION PERMIT <br /> ---------------------------- <br /> ----------- ------- This Permit Expires I Year From Date Issued Date Issued z7�/y_;F <br /> Application is hJrefby made:to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This dp6licafi6n,is made in compliance with County Ordinance No'. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION' <br /> --------------------------------------------------- <br /> Installation will serve.— Residence E]Apartment Housef] Commercial ElTrailer Court --------- <br /> Number of-livirig-un-itsl-_4 ---- Number of bedrooms -----Garba e Grinder <br /> Character of soil to a cle�J <br /> pth of 3 feet. Sand A Silt C] <br /> Clay [I Peat 0 Sandy Loam F] Clay-Loam .0 <br /> a ye <br /> S,type <br /> OW <br /> in re a on to we I , buildings, etc. must be placed on reverse side.) <br /> 149W INSTALLATION;. (No septic tank or se,60age pit permitt I <br /> I ed if public sewer is available within 200 feetJ <br /> PACKAGE TREATMENT [11 SEPTIC TANK Size------ -4--�_�-X-/-0------ Liquid Depth woo, <br /> '--ap No. Compartments <br /> Distanc <br /> D'. Box ------------ Type Filter Material Depth Filter Material _1_zf�'# <br /> Distance to nearest: Well <br /> Water Table Depth --------- <br /> Septic Tank (Specify Requirements) <br /> Disposal Field (Specify Requirements) <br /> ----------------------------------------------------------------------------- <br /> isting and required additio' n 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 San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: I <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 laws of California." <br /> Signed --- <br /> 6E D <br /> T'O <br /> APPLICATION <br /> � ~ ------------- <br /> FOR DEPARTMENT. <br /> . " <br /> —' --------''"".=m/�. _- ` c --" - --- <br /> - -----_._-- '- __ . � _ _---''---' .-'---------------------------- <br /> -------------------------- <br /> —.----_'-�-'----'-'---'-. <br /> - ' ,' -- ----'-- _''_---.--.--' <br /> -'--�—_ -_—__--_—_—_-.----�--_ --- _—. ' -- ' --''�no Inspection --- ` ------� --'—'— '---._-_— ---�._---.—.-- '—'---Do,o � '— <br /> '---SAN ]8 \QU|N LOCAL HEALTH <br /> EH. 9 l''6ORev. 0h8 <br /> ' �u�' <br />