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FOR OFF ICE USE. <br /> APPLICATION FOR SANITATION PERMIT--- ' — ' ' <br /> Per � 7 <br /> (Complete In Triplicate) nr No' ----'— <br /> ��r^ <br /> This Date Issued <br /> ..��..r�^_..� . <br /> ] � <br /> Permit Expires 1 Year Vrom Date Issued <br /> Application' is hereby made tothe San Joaquin Local Hao|Yh District for o ' h construct s�u� on6 installinstallthe work herein <br /> described. This application is made in compliance with County Ordinance x� 549 andmxist|ng Rules and RegwkmHumm / <br /> JOB ADDLdS§S/ <br /> O,kner's 44 <br /> Contractor's Name nse .... Phone <br /> Ins tallation will serve. Residence G&Apartment House 0 Commercial oTraller Court 0 <br /> Number of living units:------ Number of'bedrooms .3.......Garbage Grinder Yk...... Lot Size .115-- <br /> (Plot plan, showing size of lot, location of. system*-in relation to-wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTAILATIONi" (No septic t�tnk or seepcigeL'pit permitted If public sewer is available within 200 feetJ <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 accor'dance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner.or licen <br /> sed agents 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 in such manna <br /> as to become subject to Workman's.Compensation laws of California." <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> ..".�°.,", ,Emv«/ ISSUED ................ <br /> . ��T� ...... | <br /> ADU�xONAL [OMUMENTS --._—' � '' '-------''--'------'--' --------'----'- <br /> . ,.'_.- -_--.-__---'---'' .................... —..-------- ...... ................ ........................ <br /> ---- ............-........... .-........ <br /> --_._—�__.--'----.—'_------�.--._--.---'—'^--._''-__''—' ' <br /> ----'---'—'—.---'—'_---.L_'.--_.________.__._______ ______ __ --- '-- � <br /> —_---.--_._--- " __ ..----_—.----_- <br /> Rmm� |nup�cH�n6v ...........................-----'------'- ---''''~-~~��--- . <br /> .' —~--''.—~~w��_^�.�. .______^..________._..._______ ate _��.����������_____. � <br /> __S4N-JOAQU1W LOCAL HEALTH DISTRICT <br /> EH.l3 341''68Rev. SM 7/`1) 1 %Z � <br />