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, <br /> ���/ <br /> ' ���� - ����k�' �� ~, . ' <br /> . ~- - -- � n�PPuIC»�o="^~ '/-- SANITATIONrPermit No. '/'`'-'-'- <br /> ` n ��| <br /> +�� (Complete' p,^«a,w) -� <br /> \ / <br /> Date booed ..��-�-�'-- <br /> � �m�r From v�+�U�wwed _ <br /> � This-Permit �/`�^- ��,o+_^<5 <br />~--------�� '-` - � cono��cfand install the work herein <br /> Application is hereby 6 the San Jooqu/h�mco| Health D\�hc+ for o ,-mi� �� <br /> Rules and Regulations.. <br /> described. This ap tion is made in'compliance with County Ordinance No. 549 and existing <br /> ylica <br /> Contractor's Name <br /> Installation w, serve: <br /> \ Number -�x ��orbade Grit <br /> Water Supply.. Public System '' <br /> *m pn« ""= --'~------�'��� , ' [1 Lnom �] <br /> C6orocm, of a�| �o o 6eu+� of 3 ' | So���] Gi|��] C| [1 � Peat[1 Sandy Loom oy, <br /> - WD if <br /> Hardpan F1 Adobe Fill Material ---,e' (Phot p|o»' showing size of lot, location of system in relation to wells, buildings, ~^ ---t be placed on reverse side. <br /> | ikz6 v*Uhin2U0 {eet\ =p <br />' ��m/X��T����/��rn v`" ^"p"^ '~^- - ---,-~- ' ' <br /> | PACKAGE TREATMENT- ^ ' '' ize --- terici­11-lff�-----�--- o- Compartments <br /> . ----_' ` <br /> Distance_- <br /> J <br /> ;IT ch <br /> Lin: <br /> LEp .n-/mGu/". = / <br /> ~ .f <br /> u p� i| <br /> Rock Size y <br /> " ' ' <br /> 'l <br /> -----'--''-- <br /> Foundation <br /> --------- <br /> Capacity <br /> �mo ------------- <br /> v "=. <br /> Distance--' ' (Prev Sanitation Pornit# -------- ----------------------------------- Date ' '� '---'- <br /> n ) —'--'-- <br /> .-------'----- <br /> 5ep+x Tank (Specify Requimne — i <br /> I ' --- <br /> ` D|opoaz| Field Roqui,omanm>- --'-_.__'--'_.--'-.--' _ <br /> __ <br /> -----'---'----' -'-------'--'��'--,T--'----- __.=_.______________ <br /> -'------'-'-'----------'_'-_'---------'-------'----- <br /> ---- --'---------' (Draw existing and required addition ,eve <br /> meskoe) <br /> I � and that the work will be done in accordance with San Joaquin <br /> 1 hereby certify that / have prepared 1�s <br /> County Ordinances, Swmww Laws, and Rules and RegwlmHwmw of the Son Joaquin Local Health District. Home owner or licen- <br /> sed <br /> agents signature certifies the fo|1wnmlng' i ,Vssm edh shall not employ any person in such manner <br /> ''l c*r�fythat in the perfwrmnancemf t&e ~vork0�rvvh��� ���w ��mmx �s,, , <br /> as to become subject to VVwrkmm�n^~ Compensation laws of permit <br /> �vvne, <br /> Signed '/ - '--' <br /> MENT USE ONLY <br /> ' --_____--.--------'-----�------''---'`�-' .'_.__�______-.Duw, --------------- <br /> �no| Inspection by .--._.--�--------_-_---------- . <br /> | 'SAN J(�AQU|�VLDCAL HEAOlH D|3TRK3' <br /> 1''68 Hev. 5N\ <br />