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. . <br /> FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT ' <br /> - �� ~ Permit <br /> (Complete in Triplicate) <br /> ~o Date Issued <br /> This d <br />� <br /> Application is hereby 6 to the Son Joaquin Local Heo|th-Distr|xf for o permit to construct and install the work herein <br />� <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br />. �� <br /> . <br />� <br /> Owner's Name <br /> ~/ <br />/ ._.~' ' <br /> mome '�m��� .=��� u�onoe �� Phone <br />� ---. ---.--.--_---'--. ^ ---'----- --------------------_-----_- <br /> Contractor's <br />� /nsnzoo, will Residence <br />� <br /> _.l F1 Other_----------. ..' <br /> VZI 0,15, <br /> i <br />� m bor o+ it_sj Number of <br /> "="`'=' °' "°" '°" "=p"' "' 3 '==" """d E] S"' -E] E];7, <br /> '"=' Ej """"r `°""' �� Clay.^"""'�� °u <br /> ` H rd Adobe UNater l -N V If <br /> (Plot plan, showing size of lot, 16cation of syst'e'm' in-relation'to wells, buildings, etc. must be placed on reverse side.) <br />� (Noseptictan.-> <br /> seepage pit' pbrmitted if public sewer is available within 200 feetj <br /> PACKAGE TREATMENT P9 ------- Liquid Depth <br />� <br />� "`~."""" to . ea."= Well * <br /> ---------------- <br /> LEACHING LINE No. of Lines" -3 "='y"' "' each "'"" ~^~' `~'~' ~~'g^' °°''~~- <br />� Distance ." "="=. <br /> No <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ---------------------/ <br /> Disposal Field (Specify Requirements) ---------------- In 9, <br /> (Draw existing and required addition dWreverse <br /> I hereby certify that I -have prepared this application and that the work will be done in acc*rdaQe_:V11h San Joaquin <br /> County Ordinances, State Laws, and Rules and Rwguwxnwws <br /> becomesed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is,jss,u��,Atshall-not­ mpl 1�any perse4kin such manner <br /> as to ` <br /> (if other than owner) <br /> FOR qErAtTMENTlJSE ONLY <br /> —_ -----------------'-'—.—_'_—._- -___'_-_--.-----'--._. '-'--_---'--_- . <br /> --------'--'—_—_-- _____���_—.----.—'--.--_'z�./------__.--'-- ° <br /> ---'----- 'C�' -------'---------------f '—'---'- <br /> Rno| |nsp�chon6y. .��.. ''--_-----__---�---_'-----Date -_�r��1�.�[ --_'_'_ <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> EM. 9 l''d8 Rev. 5M ^ <br /> ( <br /> ' <br />