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t <br />, <br />FOR OFFICE USE: <br />! .—. <br />—| <br />--_---.---._'-- --] <br />APPLICATION FOR SANITATION PERMIT <br />(complete i <br />''�This Permit Expires 1 Year From ate Issued <br />FOR OFFICE USE: <br />Permit Nu -Date Issued- <br />----------------- <br />.�°���.�� <br />-~� -----_ <br />it to construct and install the work 6rein described, <br />This application is made in compliance with Cou�nty dinance No. , I <br />_549.and existing Rulescind Regulations: <br />Owner's Name.120 .... ------- C ....... ­ . 1 <br />----------------- <br />Installation will serve: Residence R?.'Apartment House F <br />] Commercial Ej Trailer Court <br />Motel 0 Other - <br />Water Supply: Public System and name ------------- <br />Character of soil to a depth of 3 feet: Sand E] Sift E] Pay [D Peat E] Sandy Loam LZJ-" Clay Loam n' <br />Hardpan 0 Adobe � Fill Mciterial..._. I J/ i J <br />' <br />(Plot plan, showing size -of lot, location of system in relation to wells, builcli'n-gsf, etc. must be plo%cd on reverse'sicle.) <br />NEW INSTALLATION. (No septic tank or seepage pit permitted if pub] jcse'�ver'is ova ildble-mith i ri.--200­f66Ti)",-----4 I <br />PACKAGE TREATMENT I I SEPTIC TANK *-r— De'p'th ----- ------------ <br />'D' Box e�*�_Type Filter M '. / --- ---------- <br />Distance to nearest Well.- -------- <br />(Draw existing Fond required addition' on reverse side) <br />I hereby certify that I have prepared this up' ' I _/ - <br />plication And that the work will %e' done in accordance with Son Joaquin County <br />Ordinances, State Laws, and Rules and Regulation's of'the Son Joaquin Lo'ca-I Health District. Home owner or licensed agents <br />signature certifies the following: <br />"I certify that in 'the performance of the work for wh' -iu <br />I iiViWW­p*_,rrF-f!;_`is ­ed,_I slial I —ncitlm ploy any per�so'n in such manner as <br />to become subject to WVVorkK an s Cam pensati "'laws of California." <br />(If other ihari owner) <br />DEPART ENT USE ONLY <br />'--_-............ <br />_'......... ................................... DATE----���,,^��~8�.- <br />............. '.......... .'.............. -_.................... -.-'DATE-- ............... <br />-------------- *'_.......... <br />- . <br />------------------ ---........... ............... <br />_'--............. :-........................................... '____-'.'—'------.-- ^ <br />' -----_.----'--_-__--'_---- <br />------------ '_-__�-------------- —........................................ :-'--_--.--------_—_-__--- <br />-'--_� <br />-------'----���� ^° U <br />Final Inspection by:..... W. <br />---- � <br />--------'- Date <br />------=v�y <br />n^wm ���SANJ[hAQUIN LOCAL HEALTH DISTRICT nm2/»n»p/ '/»^m* / <br />