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APPLICAT]qW FOR,:SANITATION PERMIT <br /> ---------------------------------------------------------- <br /> iz Date Issued <br /> Th ermit XpVes 1 Year From Date Issued <br /> Application 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' �ornplidnce with,County Ordinance No'. 549 and exisptp Rules and Reg�;ations: <br /> JOB ADDRESS/LOCATION A JZJ_ ------ CENSUS TRACT ---- <br /> Address <br /> Installation will serve. Residence D�Apartment House Lo Commercial :E]Tra i ler Court <br /> � (P1ot plan, showing size of lot, location of system in relation tzvveU� 6o||6|ngn, ob. must; be p|mcm6 on reverse side.) <br /> NEW (No septic tank o, permitted if public sevver |oavoUo6|e in2U0f�et) � <br /> --------__-_ ` � <br /> PACKAGE TREATMENT SEPTIC TANKf - �� Depth -------------- <br /> 42e <br /> -_' <br /> --- Tp�tCopoc' �~ <br /> Compartments 7................ � <br /> � <br /> Distance to nearest. Well ------S-5-0--------------------Foundation -- �� .� -' Prop. <br /> k �Lh�ne - ' �'- <br /> '_'' <br /> LEACH|NGL|NG -,rNo of Lines -';��'--�-- Length of each line--- Total bmno+� ------------- <br /> 'D' <br /> --'-- <br /> 'D' Box,-/-.. Type Filter Material DepthFilter <br /> l& <br /> � <br /> F| . kAu��(o| -. ---.----_'--.' `^ <br /> Cxmonce to nearest.. Well Foundation � �D ' Line <br /> � <br /> SEEPAGE PIT <br /> ' . <br /> | N/oto, Table Depth -__.—'__-_'_'_'-�ock Size ._—_'--._- <br /> � � ^ . ` <br /> D|moncnm nearest. Well -------.---_-.-'Fuundohun ------------ ------- Prop. Line <br /> ! (Prev. Sanitation # --------------------------------------------- DoMo ---------------------------------- <br /> Septic Tank (Specify Requirements) <br /> ---- <br /> --:°-------------- <br /> ----------------------------------------------------------------- _-~---------. <br /> Di-'-_-| Ro|6 (Specify Reqd|rnmnnm) .' ' . . ' ' <br /> � _--- <br /> -.--.--^=--_.—._—.------'--.---.—--'----_—'—__--_---.-___'''_-----'-'_-_- <br /> ----.-------'—_--.--_------_-'---'_-^--'----__'_-----_---.__---- <br /> (Draw mdshhgand reqyired addition on reverse side) <br /> � <br /> ] hereby certify that U have prepared this application mnd. thmm the work will be done in accordance with San Joaquin <br /> � ' <br /> � ��un� �mJhnmn*�p State Rules�u � mn� Regulations w� ��� $�� �w�qu�� ��m�y ��mh� 0Gw��� ���w w�pnwv w, ]�w�- <br /> swd agents signature certifies the 6*Dwvv ng/ ' <br /> ' <br /> "I certify that in the perfmrnnanc' wfthe , rkfmrnwhychrh;mp*omytUmimmued' Ushmylnwt employ any person insuch mmammen <br /> � <br /> as to become subject to VV rk ' ` Compensation laws of California." <br /> Signed ��x�' ---'---' °=''"' <br /> ' By ---.]�J��^ ��.�� ------.. T|Ne -----.-------------------- <br /> � <br /> (if other than 6n <br /> FOR DEPARTMENT USE ONLY <br /> DATE <br /> ADDITIONAL COMMENTS <br /> --------------------------------------------------------------------------------------- <br /> --------------------------------- <br /> Date . <br /> � SAN JOAQU|M L[tAL HEALTH DISTRICT <br /> ` � ~ <br /> E. HL9 l'\68Rev. 5N\ <br />