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. . <br /> - <br /> � � . . ~' ` <br /> '^~~ OFFICE USE- <br /> APPLICATION' — FORn�. ~~.,.� - <br /> ' ' ~ <br /> Permit No. _7 ---- <br /> 3 <br /> (Complete in Triplicate) <br /> ........................................ Frwm � ��u�� Date Issued ....... <br /> U� <br /> ' . <br /> /5 ! <br /> p6 Joaquin| Local Health District .,for u construct and install the work hmreherein , <br /> described. This application' ' made|m ��m \n compliancewith h [ounYy Ordinance No. 549 and existing Rules and Regulations. <br /> ��'� �� T�� c�l <br /> JOB ADDRESS/LOCATION .',�!'�-�'�.-.��_..����....---����-'�-�.� -..--..---�-.-�cmu�� -�..�.--.-_-'`- � <br /> - - ' '- pn� �y���� ��;V�� 1 <br /> C�w'n�r'n Nonn� _--.'����t`-.`"^����f�.�---.-.--__------'---.�-..^----..�-. no ^°,�.~-..-�-_,---_' � <br /> ` l�m' <br /> Addr6v* -_..---.=~����4��`---..�--------'------'--'-- -, --'^ 'r----'r'---'----'~---'--- <br /> . _-�7u ~ �" ��_ :u� l�. ' <br /> � osNu,n. -�---..x.//�-A�/���. .��--. �-..'~��.<c­.--.--Lcenue # <br /> ' <br /> |nmmUwt|on will serve, . Residence, rtmentHouse 0 Commercial []TrpUov Court C] <br /> N��e �] �+her ........................................ <br /> - - <br /> ' - ^~ <br /> Nwn6' er nf |Wng onhs'--/`- Nunbmr q+ bedrppms G"n6er _. . Lot $| <br /> ce ._4.p�ff.'..'-'.----'-' <br /> - � <br /> ! ° <br /> VVurer Supply: Public System and mmme ....................... .-_'--_-�—.----.-�_'�__.,�-.--'�..'_`,-- 0 « <br /> (Plot plan, showing size of lot, .Iocati on of. system' in relation to wells, buildings, etc. must be placed on rev erse side.) <br /> NEW INSTALLATION: JNo septic tank or seepage pit permitted if pVblic sewer is available within 200 feet) <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'accordaince with Son Joaquin <br /> County Ordinances, $late' Laws, and Rules and Regulations of th� Son Joci�uin.La�tal I Heal th'.01 strict. Home owner or Ilc6w <br /> sed agents signature certifies the fo:lowing:; <br /> "I certif, that in theAperformance of the wdrk'for which this permit is Issued, I *hall not employ any person 1h such manner <br /> as toZ-beciorne.subject to Worklman' Compensation laws of California." <br /> By ................ ------------6.1 --------------------------- - ......­ Title ............ .............. ...................... <br /> (If other than owner) <br /> da FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED -_---_---..__-.`--.-__. DATE ' <br /> BUILDING PERMIT ISSUED - ''....'_-.�---_-.-----'-_'''-'---.__'_'__.........DATE <br /> ` <br /> --. ................................. <br /> ADDITIONAL COMMENTS --._--.-_----_--_--�'.-- .......................... ....... ............... ........ <br /> '- <br /> ................ .................. ............... -- ........................................... ......................... - ................... ..........---------------:............... <br /> -_-_—'_—'' '----'------''''—^-------'''!'-----------'-- <br /> -._.------. --.--'—' ... ----_----.-._- -^_._ <br /> ��n�| |�ope�|um 6�' .- .�-----.__-_---..-----.--_._-.�otw��-.��._--'�z���_.._-'�. <br /> ` <br /> SAN JOv4QUIN LOCALHEALTH DISTRICT <br />