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: "ICE <br /> OFFICE AftCANC3N FOR SANITATION PHtMIT <br /> P9rmit No. .��-•4 7 Y <br /> Yu .. . .........------ tcomplete In Triplicahl <br /> ,.. .. `. <br /> VOWS pate Issow x <br /> l hls Potnolt tex in81 Fear.I roto 5, <br /> -------------� unit to construct and install the work ltereitt k ; <br /> e Application is hereby made to the Sem Joaquin Local Health Distrlet for a pe <br /> % a ' <br /> described.This applicatlon is made in car»pliance with County Ordinance Na. 549 and existing Rules and Re+Ju1 � <br /> c>:Nsus mcr <br /> 3C S ADDRF55/L ............... ..PhWJ ^ t y <br /> :1r I'I I�/.•�: ................ ....... ....._...... ,.............. <br /> } Qwner s l�lurtg'r .' ? :: ? l ................^........City ................................... <br /> �Addrbss r?.. .. Lleonse aP ........................ Phone .................... t� i <br /> t;onttaews Noma. ='�`.""..._..1--:................ .... .._._._.......-....._.......... Court ❑ <br /> Ya` - <br /> Residence Apartment House Commercial OTm11er <br /> installatio»will.serve= , s t <br /> x M6te10 d*f .... � ` <br /> e Cinder ... Lot"size ...-•»�; <br /> x Nu�riber of living units..............Numiser of jsedroorns ...:Gam ..». ..privet# <br /> BMs h �a tem and name ....11 1 % I "N. <br /> ,v Water StPp1h public Sys Piet❑t dy Loom Q: dory Lentil xf <br /> 4 ;�<+ Sand 'SIIt(] C.!W <br /> t`r sGarkhk of soil to a depthof eet� <br /> } y kk <br /> AdobiO fill <br /> ¢, a trust be plaard <br /> [� q{�Y`�,r�„�.."^r.a+ms,suiem.a•ae�-.sz--ae_--n.tsrd a� r ..r. <br /> 4, ; r�ar fi� aa�r "�'- rn In ir3ldtlbn t0 wells,buildings� ,�* s <br /> f tion of .-*I*lh Wit}fm <br /> jar SlIQW1tF SISe.4 ,tOt,,ltlCa arm"' r.�`,�� �� x M Fa y <br /> perrnifti if publlC teRiVer ble <br /> �r�.�y,� • �Wy� avalla y� ,mac <br /> d '�"F'"�IrR'6 ISTIGW.A'laltA! t Ii1i+J SeptiCM1ta�1 's r� .. •tiH:k, 'PT,� a r" r fr It -. - 1.1 uid ••.. ......v.w "�"*ea+. <br /> 3. <br /> r "5 ..rNt�wi <br /> a A #MJCl'TiC TANS _n r jlAal fal. No Colnpaul <br /> e h' '4y, iii R�,^:a y •h S S-'S x a}N�.2'Sn}' aily <br /> prat%Ntte... .........+.•a <br /> � � r, t?�startce .tm+n6ri ate ®li` Ilna Total .......:.. <br /> Langur o <br /> No of Linea f ea .= <br /> �,r .- r Iciltbr Matertai' ,..-„ r <br /> ;t•,r..-'"° - ..,` c-`D Flax=;`. "-lfypa Flltet 1Nalerlesl '_•,�.. .. ... ....._.. <br /> p• a R ' ir?k•4,X�y� ° a`sc_ f} �. -?t z-+7'dk�.-,sg? a „t F '^4 .... r'�l�a�ialr w Line t'�•. <br /> to hearesh,vl(etl R � .x <br /> y l��star+fie Filled Yeti Y] 1 <br /> Nvittbw <br /> Aai?i fl CleFpth j1loneter .. _ <br /> .................Rock Sime <br /> 7ab4e Depth Hon Pro <br /> ............ ..... p. Line ...................— <br /> 53M �r l _ Distance to nearesh Well .... ............. a .- 1 <br /> lcound ' <br /> a }� 11D311FTI N(E�eV. Sonitatioiti Permit _....... . Doli ........... ........... .......... <br /> e..n..t.s..l............ .. ...... ......... <br /> an ( pecfyRequirerrentsl CTS ......". <br /> ...... ......�.�....`..........:.� <br /> 7rosalFld: Spclfy 7equlremr <br /> ................ ......................... <br /> ............ ................ <br /> ............ .� <br /> ,,. <br /> - - .............................................................................. ...............:...........-.....-.._ <br /> ....................................... <br /> R prawn existing and required addition on reverse tide) <br /> r area thio application and that the work will be done In accordance with San Jsagvin <br /> l eri�iy,eo'tiiiy that I have p +p <br /> County.Ordinance" State Laws. and Rdias and Regulations of the San Joaquin Local Health plaMet.Herne owner or Elan- <br /> Bed agents slgnaturo certifies the Fallowing: le person In such mamar <br /> .,I certify that in the parl'ormanco of the work for <br /> wrl�lch this permit is Issued, l :tiall net employ arrt► <br /> as to became subject to Workman's Compensctior+ carps of Celif�*rola:' <br /> c' s r-{.. .r t owner <br /> Signed 1111A. <br /> ,i itle .. ................... ........... <br /> (!f other than owner) F • <br /> '. FOR DEPARTMENT USE ONLY . <br /> ........ <br /> i <br /> �•' ................. ............... <br /> APPLICATION ACCEPTED BY r ........ . .DATE ....... .- <br /> .. <br /> .... <br /> BUILDING PERMIT ISSUED . ... .......... <br /> ADDITIONAL COMMENTS <br /> .... ....... .. .._....._... ...-..........._..._........._....... <br /> ................. ....._- .... r•_ -_ <br /> 1. ..,.0 ...... .. _ .. ................. .Date .'%-.�5_..fz. .. . ... <br /> Final inspection is <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> `� ' E. H. 9 1•'SB Rev. 5M <br />