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` <br /> FOR 0I*'ICE USE: <br /> (Complete in TApficarel) <br /> Date Issued <br /> This Permit Expire"s 1 Year From bage!'Issued <br /> Applicationtis hereby made to the San Joaquin"Local. Health District for a permit to construct and install the work herein <br /> described. This�appliccitic,6�is made,in compliance with County Ordinance No. 549 and existing Rules and Regulationsg <br /> Aa <br /> JOB ADDRESS/LOCATIOW ....... <br /> Installation wili serve-. Residence [-],A t t H e,0 Cornmercial�CTraller Court !0 <br /> pa�iTen 044 <br /> Character of so t i I to a depth of 3 feet. Sand`C] Silt 0\ ,, Clay.F-] Peat n Sandy Loom,T<Clay Loom '[:] <br /> Hardpan*1 Zobe M*,'Fill Material If yes,type--_----_---_ <br /> (Pl,ot plan, show�ng size of lot, location of systern in. relation io',wells, buildirgs, etc. must be placed on reverse sidel <br /> MEW ]NSTALLVBON� (No septic tank or seepage'pit permitte&if pyblicsewer is available within 200 feetJ <br /> JZ <br /> I I­ 1 4... ........... <br /> (Draw existing and required addition on reverse side) <br /> hereby I �navq prepared this application and th at the work�wofl be done in a zewdufas with $un J@@q-u)iR, <br /> County ard�nmnces, Slats luws, and Rules UnA Reguinflons C*f the Son Jlavqu�n �oc@� Heagqh NMVW� Home @Wno?w H(m,2- <br /> ~_~ ~=--- _= a_--_--' -' <br /> Owner <br /> -------------- <br /> FOR DVARYMENT USE ONLY <br /> ' <br /> APPLICATION ACCEPTED BY _____��.__��-_��/�.________ <br /> BUILDING° ' '------ i <br /> _'--------- ..............'--'--_- _^_-- '-__ � <br /> . __ _- <br /> __ <br /> ~~ Rn�1nw���k�n ��C���~''�� ---'~-------------------~~'° ----'-----'----~-'---' ' <br /> SmNJOAQ8U|N LOCAL HEALTH DISTRICT ' <br /> � <br /> EM. 91 Y-'�.l 8 lRev. S&8 . <br /> ~- ` <br />