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FOR OFFICE USE- <br /> APPLICATION FOR SANITATION 'PERMIT 343 <br /> lComplete In Triplicate) <br /> 9,7 <br /> Application is hereby made to the Son Joaquin Local Health District for a permit to constmict and 'thstall the work herein <br /> dqscribed. This application Is made in compliance with County Ordinance No. 549 and existing Miles and Regulations- <br /> 01 <br /> Addre <br /> Installation will serve. Residence I*-Atl5a-rtment House 0 Commercial OTroller Court 0 <br /> Water Supply: Public System and name ......... <br /> Character of soil to a depth of 3 feet- Sand 0 Silt 0 11�,C_lay 0 Peot C] Sandy Loam 0 Clay Loam B--� <br /> NEW INSTALLATION: (No septic tank or see age pit permitted if public sewer Is avoilo�le <br /> ------------------ <br /> (Draw existing an required addition an reverse side) <br /> I hereby certify that I have prepared this application and tl�at;�Ae ��* k ��Jll ie�,d' ione In accordance vAtfi San Joaquin <br /> County Ordinances, State Laws, Ad Rules and Regulations of the- San Joaquin Local Heal&Distdct. Home owner or 11ceit. <br /> sed agents signature certifies the following: <br /> "I certify that In the performance of th4 work for which this permit Is issued, I shall not employ any person in such mon"M <br /> as to become subject to Workman's Compensation lows of California.' <br /> lif other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> -------'_-------.--._-'---^...- ' ---'—'__-_--._- <br /> -�-._----_.'----_------- <br /> � <br /> � -------_-.- _.~'------------.---- ---- <br /> ---_-_-__-' -'--_---'--_-.------' 1. . ''Fno| \n�pochumby .. � ---.------_---.-----------...�oYe .�����. -----' <br /> EK 13 Dh I-68 1�n�° 5M /7 �--^ tC�CA� �E�LY� �o � ' °/~^ 3M <br /> ' <br /> ' — <br />