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' <br /> FOR OFFICE USE: FOR OF <br /> / I , <br /> � <br /> / <br /> ------ <br /> 4i <br /> | ' This Permit Expiresj'5yeaiTrprn,.,D,a, te lisued <br /> -----------------------------i------- ( L._,/ <br /> Application is hereby made to:'the Sj n Joaquin Local Health District for a permit to .construct and.install the work herein descrl'bed. <br /> This application is made.in compli ce with County Ordinance No. 549 and existing Rules and egulations; <br /> Installation will\serve: Residence Apartment Hotj§e Commercig] P Trailer Court E] <br /> Motel E] <br /> ' <br /> ' Nu��er �� |i�ing '_..Num�erof6�6n»om�--' �o,6ogeGmn6ev LotSizo, ^��~_--'.'-'-'--��' ^ <br /> . . ' <br /> i Water Supply. Public System and ~ /��� <br /> Cha <br /> . th` f 3 -- -- � _� � -- . -- <br /> ' <br /> Poi <br /> ize <br /> � . showing~ -_ of lot, -- �_- system_ in r- wells, <br /> '~ - _ -- <br /> ^~ ""°'"~^=~''==' "`" ^=p" v, u��poy� pit permitted if/ public <br /> PACKAGE TREATMEN. ^ ^ SEPTIC-TANK <br /> ' � ' ' I--'Total <br /> ' <br /> LEACHING LINE [ ] No. of Lines �»��� of each | n& | ^Tota| Length <br /> , .' e� . _- <br /> ( Water— Table --,^' -------------- <br /> ---' to nearest: <br /> . --. ~~.,A~~.^ O . ".", Sanitation" ,"."". <br /> ' ------ <br /> Septic �� <br /> ......... ../ <br /> Ordinances, State Laws, and-'Rules ont�_Re�ulations W the Son'JoaquinAocal Health District. Home owner or licensed aqents� <br /> . ition on reverse side) <br /> (Draw existing and requirej a�d <br /> I hereby certify that I have prepared this application and'that 11hi\, work-will be -clone--irf-iiccorclance with San Joaquin County <br /> signature certifies the <br /> "I certify that in the performance'of the work7fbr which this permfli is issuecl��l s9all not employ any person in such mp; nner as <br /> ' ~ <br /> L -=--.. -~~~---- ~~- - ~ - ' <br /> Owner <br /> � °r....... ................. ------�x---.,�`'---� 'z-' - ' �/ -- Ti �---------------- ` <br /> (If other <br /> USE ONLY � F <br /> | <br /> ' *ppuC*||Om ACCEPTED <br /> 8Y. u*/-� ------ <br /> r <br /> - <br /> r /D|V|S|DNOFLANDNUW8ER <br /> -''--^''-~'�---- <br /> � <br /> ADDITIONAL CO/NMENT3�-��--�--�--~�~�-. '� ----'-----------------------.' -�-- <br /> � ~ --------------------'�----. <br /> / �-------- ------------- ----�;��-------.--- ������ � <br /> ' --.-------------�. ' -^^-.................................. ............. ------------------- ------------------------- ----------------- ....... <br /> ----� <br /> --------------------:---- ' ---- ------------------------.­----------- ...... ------------------------------------ ------- --- - -_� <br /> Final |nspeci/on6v'. -----------'----- -------- --- .............. Date.......... ------ .-. -' <br /> EHu24 / / SANJOAQU|N LOCAL HEALTH DISTRICT ( F&S 2/677 k.E*. vm3M <br />