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Hardpan ❑ Adobe ❑ Fill Material.. .. It yes, type""._.. . ... .. . ........ <br /> (Plot plan, showing size of i.,,, location of system in relation to wells, jildings, etc. must be placed on reverse <br /> NEW INSTALLATION: (No septic tank or seep/age pit permitted if public sewer is available within 200 feet, <br /> PACKAGE TREATMENT [ ] SEPTIC TANK (G)' Size 1,r1j�)--s1-- ----- -Liquid Der <br /> Capacity../-?1 9P1 ----Type `J/3.�f.�lf//.moterial_- -..No. Compartments_.. <br /> Distance to nearest: Well... QW-74- --_.... . --Foundation-. ___ - Prop. Li <br /> 6 � <br /> LEACHING LINE [ ] No. of Lines _.... .. ........___ Length of each line ------" -......-". . Total Length . <br /> D' Box _.f Type Filter Materia+�Pr/Q 6efth Filter Material....._.-......... <br /> Distance to nearest: Well---- . _.-._ Foundation----- ------- ----.__-....Property Line_." <br /> SEEPAGE PIT [ j Depth-. ..-.. - _ Diameter- .........-..- __Number-_---------.--------- -------- Rock Fill <br /> Water Table Depth. -------- ------ ----.._._. ..._........ ------..Rock Size..- ...._.... -._.. <br /> Distance to nearest: Well _---------__.- .- _ _............Foundation.. ... .. _ Prop. Li <br /> REPAIR/ADDITION (Prev. Sanitation Permit#......... ............_.....__.. ._..-------_Date...... <br /> Septic Tank (Specify Requirements) - <br /> Disposal Field (Specify Requirements)......... ..........,. ..........__.-_.__..--..-----------------------_ -------- <br /> --------------.._-.. ...-._------------..................-------...__......-. ------- <br /> ..-----------------. .................. . ......... --------------- ------ ...... ...... .. <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with 5 <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District, Home owne <br /> signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person <br /> to become I to Work an's Com a sation laws of California." <br /> Si necf^_ rfLfp ` '- -A/[ _ _ --. - - ...Owner <br /> By.... <br /> _- Title_ k .... .. <br /> (if other than owner) <br /> FO DEPART S NLY <br /> APPLICATION ACCEPTED BY-"-..__ DATE <br /> _.. <br /> DIVISION OF LAND NUMBER_....-- .._- .....-----_ - ._-..... ..-.... ... -"... DATE. ....... <br /> ADDITIONAL COMMENTS.. ........... .. - - <br /> - <br /> _. <br /> Final Inspection b Date. ..__..._ _. <br /> EH 17 24 SAN JOAQUIN LOCAL HEALTH DISTRICT <br />