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FOR OFFICE USE- <br />! <br />..................� <br />APPLICATION FOR SANITATION PERMIT <br />(Complete inTriplicate) <br />This Permit Expires I Year From Date Issued <br />'~ <br />ApplicationFOR OFFICE USE: <br />Permit <br />Date Is sued. <br />hereby made to the Son Joaquin Local Health District for a permit n*' and install the work herein deocribed | <br />This application is mode in compliance with County Ordinance No. 549 and existingRvies and Pegulationst <br />4/ 444 <br />Contractors Nome. U <br />Installotion will serve: Residence lftx-lb Apartment House Commercial f -I Trailer Court C -j <br />Number of living units t .... Number of bedrooms.. Gairboge Grinder. <br />Water Supply,, Public System and name ..... - Private <br />a Cloy Loom ITZ, <br />Character of soil to a depth of 3 feet� Sond El Silt 0 Cloy M Peat L�] S ndy Loam;n <br />tPlot pion, showing size of lot,.Ioc�ation of systern 'in relation to wells, buildings, etc. must be placed on reverse side.) <br />NEW INSTALLATIOW (No 'septic tank or seepage pit permitted if public sewerIs available wit in 200 feetJ <br />PACKAGE TREATMENT SEPTIC TANK Size 6 .401 <br />_A4 Comportment <br />un ation <br />Distance to nearest. Well .......... _Io' d <br />LEACHING LINE No, of Lines ........ ...:.....Length of each Total Length . .. ........ <br />D. Box'I ...... lype Filter Material ... ... .Depth Filter Material ....... <br />Ink A Property Line-:... <br />Distance to nearest; <br />SEEPAGE PIT Depth Diameter_...!V,. of ..Nmbet.. ,�L_ Rock Filled Yes F1, No <br />I hereby certify that I have prepared this application and that the�work will be done i,n accordance with Son Joaquin County <br />al Health District, Home owneir or licensed agents <br />Ordinances, State Laws, and Rules and Regulaiians of tho-Son Joaquin Loc <br />signature certifies the following: <br />"I certify that in the performance' , of,the work for which this 1permit Is Issued, I shall not employ any PO -On In such manner as <br />to become subject to Workman's Compensation laws of Cclifiirnio." <br />(if other than owner) <br />FOR DE A T <br />APPUCATiON ACCEPTED 8Y ........ ... <br />~~�' <br />. <br />DkHSu]NOPLAND NUMBER ........... '... <br />DATE.,�//�o <br />'-^-'/^-`r--�--'�--- <br />---.~-DATE- ............... ........ ..... <br />--__� <br />---*.-~-_-''--~--'_�- <br />^��.,..^....^-_''-..—'---''--'-----_--_- <br />�_ '-~--.-_-__--____--_ <br />-~--'--_'_---_---''�-.�--_____'_-.''-~'-___-~-'_---~-~~.- <br />............................. ...... `.,_----..�......... �_-........ .......... ......... -................. ....... ....... ........ _'........ <br />.'~_. <br />-----�--'--� <br />Final Inspection by..... C!'; &�_-............. --�''-^'-~-^'--^~�'�— <br />�m-'�u-wv-AIV. _/n—*** <br />ex 13 m SAN JCAQU|N LOCAL HEALTH DISTRICT <br />