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Hardpan ❑ Adobe [ Fill Material -._. _- - If yes, type <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed <br /> NEW INSTALLATION: (No septic tank or see ge pit permitted if public sewer is available within 200 fe <br /> PACKAGE TREATMENT [ ] SEPTIC TANK Size. Liquid iDeptl <br /> Capacity );:�lrcv -.- Type��RL` $: Material..- _ . ._- No. Comportmei <br /> Distance to nearest: Well //40 -. ;-_-- -- <br /> ------- ------ Prop. I <br /> LEACHING LINENo. of Lines 3 Len th of each line O Total Length <br /> 'D' Box Type Filter Material //4XA4Depth Filter Material <br /> Distance to nearest: Well !Q'U-___._----- Foundation -:P5 __ -. Property Lin <br /> SEEPAGE PIT [ j Depth ___. Diameter ---------------- Number._ -- '_ _.-..... Rock Filled <br /> Water Table Depth - ---- — ------------- - ��-.........Reck �iz//e ... -- -------- -- <br /> Distance to nearest: Well ._____.............. __.__.....LFound'An ......... Prop. L <br /> i <br /> REPAIR/ADDITION(Prev. Sanitation Permit# .... .__ . ...... - Date . _ <br /> Septic Tank (Specify Requirements) <br /> i. _ <br /> Disposal Field (Specify Requirements) ..--- ---------------------------------._ <br /> (Dra'w existing and reqad. ition,on reverse side <br /> I hereby certify that I have prepared this application and that the work will be done in accordance v <br /> County Ordinances, State Laws, and Rules and Regulations of the_SanJoaquin Local Health District.Hom <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, 1 shall not emplo any perso <br /> as to become subje to W kmo Compensation laws of CaLforn a." <br /> Signed . ` -setG r ----. Owner r <br /> By . _- _. - __ ._...- ._.. -.. - -- -- _. . Title <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY _ <br /> APPLICATION ACCEPTED BY DATE <br /> BUILDING PERMIT ISSUED - . -.-. _- _ _ __.. _ DATE - _... <br /> ADDITIONAL COMMENTS <br /> Final Inspection hy_. /G `i/U .. ----- . .. Date .. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 13 24 1-'68 Rev. 5M <br />