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FOR OFFItE USE,- <br /> (Complete in Triplicate)' Permit No'. -7-(------- <br /> TDate Issued _1-------I-------- <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 compliance with County Ordinance No. 549 and existing Rules and Regulations. <br /> Contr�actor's Name <br /> Installation will serve.' Reside"nce Z Apartment House Commercial F�Trailei Court ;F1 <br /> wurnb& of living units:----/-----.Number. of.\bedrooms Grinder -06---- Lot Size 6_&Ci?Aa41_9. ..... <br /> Char <br /> acter of soil to a depth of 3 feet. L,Sand'E:]\, Silt[:J Clay E <br /> Peat Sandy Loam Clay Loam <br /> (Plot plan, showing size of lot, �I,Ocation�of system in _r�eldtion to- wells, buildings, etc. must be placed on reverse side.) <br /> __FN6 septic' f6n or see age pit permitted if'-PUD11C sewer is available within 200 feetJ <br /> NEW INSTALLATION: <br /> Capacity _/WA------ T ype Material--- No. Compartments _74�--------- <br /> Distance to hearest; Well ---2 <br /> ------------------------- <br /> (Draw existing a6d,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 San Joaquin <br /> County Ordinances, State Laws, and-.Rules and Regulations of the San Joaquin Local Health Distrilct. Home owner or licen- <br /> sed agents signature certifies the folld'wiing: <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of'California." I <br /> ' <br /> Signed ---------- ' --'----_--_ �vvner \ <br /> — x <br /> oy��' -------------------------------- The __-------- <br /> (if other <br /> /nonovvnen <br /> � ~ <br /> - FOR DEPARTMENT USE ONLY ' <br /> APPLICATION ACCEPTED BY <br /> Final Inspe <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> . . <br /> EH 9 l''68Rev. 5X8 ' / <br />