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`-E'° °' APPLICATION FOR PERMIT
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I HAVE AT THIS DATR A CONTRACTfiTII TT[E HEMX MANID CON-
TRACTOR TO CONNECT THE AAM SWSc1tliBED EnmNa prRLI IN{ APPROVALS INsm 1 n
TO THE RUSuc Smrm
SIGNED THIR Y 0 D-_ NEW Hbun Srwn
OWlml OR CO NECTADDITIONAL
OWNERS AGI N'C -= -� BUILDING ON WORK
ADD SEPTIC TAN[.SEEP.FIT(S)
MD�OE DRAiMFIELD
1 HEIIEST AGENO*LIDT THE I�QE THAT DM It Cr HHAEVI READ THIO APPLICATION
AND rPG06L 13 _
WITH ALL cOoUNTT UDHWC15 AND StATICT D LAWS REGULATING TO A j AI!�j !Er R
PLUMBING
AN sEWIRS. SEWAGE DISMlAL ETSTE
1 HEREBY CERTIFT THAT 1 AN FROPERLT REGISTEM MDMR DISCONNECT FLU%AND
LICENSED AS REQUIRED E7 LOS MGEM COUNTY D STATE OF ABANDON HOUSE EN
CALIFORNIA OR THAT 1 AN THI LEGAL F T" ABOVE C[FILL C TANKS
RESIDENTIAL PROPERTY. sgF -FL i CISSr00
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OF PERMITTEE
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