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<br /> At-111.1CATION Foil PFII"ll :fib
<br /> IN LOCAL HEALTH Ill ,tt1C1
<br /> I IAZU.TON AVE., 51'C'.Cti'''
<br /> 4;Ir!Irhrn)C i'2og) 4Fi6 (i?1i1
<br /> LiCf I.iFS 1 YEAR FPO
<br /> M DA F I;i51fED 'r+r17/ .ry'i �tl/ +`
<br /> f 4 11T ' t - _ - -
<br /> if:(,ietlalt (ti)lic;iw)tle in i
<br /> In, a pgtrrn,t 1n Cnft::!ruC.! r,r 11 t �„}tall the Will It tn••r•,.1n tb_, ;` ,,„I tl•.,•..An_I c,.,.S,�uS
<br /> Ag,plicatu,n,s hrrel;v marlr.tr-tt,r. n .""';"" '
<br /> ..- !u' raga ni No. 111112 Inr�„:3 „i^.v•,uu1 the livle::!nd
<br /> mad,t
<br /> in Cnntphanae will+Sol%J arin,n
<br /> lact,l t'rni!h Drst,cct� /../ �D
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<br /> Job Adrtro5s - Y /-C..- / ?.547
<br /> Owner's Name .f (
<br /> Contlaclor ���-f_— ' __—� ni:STRi1 :III,N /1
<br /> . --'�J'':'„ I I � F'v' L.L RF PLACEMF.tJI ! i -pi ! '�•.� '
<br /> TYPE OF tYLLL1PIJMP: SYSTEM REPAIR : OTFIER
<br /> --- -- PUMP Itv:.t nLt ,l :) ;
<br /> ;E�VkTi I,RfF.S _�.�...•.. )t:r'f1tiAl. f•LO.___—__
<br /> DISTANCE TO NI AREST: SEPTIC 1 AN )I+IF Il v^.FLI._.—_---_ oil 5Isu.l4'+ 1�O
<br /> --------.___..._.----- FOI.INUA'i lOtJ A(il{ICLILT!JRE 1vFLLr. _. . -
<br /> - -----c 'TYf E OF �:'F.I! I it.1PLEt 1 AREA CONSTRUCTION til'f',(aI IC.A71 f S - q „1 47r 1'
<br /> INTENDED u E - ' niaW n[Well £+,cawati)', !"
<br /> (_' Open
<br /> Ll Ir,duatrial
<br /> ,,,,�.. Type ul Casmgt - -
<br /> S-1 DomesticlPrivat" 1 I Gravel I'ar.t 1
<br /> I'l Puhli;.
<br /> I l 00,,,,rf t,•Ict Dr.pth of fi•r=ta Sall
<br /> ,nl,t,rnn, i,,•1,t1, f '-,Inr„ Surleca Soot lnstaho I by
<br /> faille,Work Donr
<br /> Repair Werk none I.i Type of
<br /> _ 51•;d�ng Mat^riot Itop 56'F __ -- �-------------"-"- F'-' ,•�
<br /> Well Destruclfnn fJ Wn': Uiorn,:;n f he tAmerial 1Bolow 50'S --._ -- ---- ' --� _._----..
<br /> Depth __ n
<br /> -"— T--y •AODITION l I O£STR111:110N I 1 [No 5k:pl`wilhin 20[71LC�['I�.�i d pub6r. sewer is
<br /> OF S[P71C WORK: NEW IN7-1 n1 I'%1 It1.: . '' '';' 1
<br /> Installation will servo: Residt'ncn A
<br /> Number o1 living units: Water table depth
<br /> Character of;oil to a dr.I,th of 3 Irnt _ Ca{,achy— .-_•__ ._—_. No. Compartments
<br /> [.1 Typo ktfgt
<br /> SEPTIC TANK Method of Qisfiosal
<br /> ��
<br /> PKG. TREATMENT PLT.1 ! It - Prorty Lina
<br /> Foundation-.._- _
<br /> Distance to
<br /> - _ - ---- ---- — Total lengths ----' -- —— —
<br /> LEACHING LINE C1 No. F .,nnp1h,+I lir,r,; — ---- —--_-
<br />' Property Line
<br /> FILTER BED [ I Distarce t,, iwarra Well --•-_-_- Foundation 1 Y - '-- —^�--
<br /> - V 1 DnpFl,
<br /> SEEPAGE PITS f rn,'ttlat;on .-_ .- Property Lina
<br /> SuAsf 5 4 I f)rstanrrt tr. n,•n,".t• Wr'll - --- r��--
<br /> DISPOSAL PONDS I l
<br /> ee with San Joatluin
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<br /> I hereby certify that I have prepared this a'wPlic.""On'sod Ihjt lha work will Gu dune it)ac.ordar, r.ounty ordinances, stale!a ._, a-id
<br /> n r
<br /> rules ena reputations of the San Joegn,n I.0c31 Ileaith Diclrict. ll oe_
<br /> lz
<br /> }{oma ewnar or Iiconsad agent's s,fanfare cnrlP�s.tho lnlinwing: "I certify that in the po nrmanca o1 the work for V!b'�c"ro work man's compalkJF0
<br /> Homey any person in such mann -T:to tu•cenu; ub'e s 1<,,vnrkman's compensation law of California,"Contractor sryhiring u::ub contracting signature
<br /> �:., y t`��� -- mac �Z1IL !��( �/6 �7
<br /> certifies the lallnwin I carlif tor+ /th""t 4Z:n1 ff,e w r which this o ;t i ircvo I s ell Io Pe
<br /> tion laws of California." 1 r
<br /> y.fAri ,, I, r.s. •to drawing o rev4rso side.
<br /> The applicant st call for r 1_prjRdc{Para: _ _-�----
<br /> Tit a:
<br /> Signed)( ��/���
<br /> F>1R DEPARTMENT USE C NLY r Q
<br /> ( _ Am.
<br /> na — !
<br /> _ �C,�_G4 _
<br /> Application Acrn[atnd by .__. _ oma� �1);l _ 7ate�
<br /> r i.v'R q [)rh. Final inspection byt` —_— r —
<br /> Pit or Grout tnsmetion by 1n+= Cy{;S trl.'1 ti 't�--�- t
<br /> Additional Comments; 51•c-.__i."
<br /> 1 tI., C] Tracy 835-r,'95
<br /> I.I Stk 46Ci-6701 17 Lodi I St t4%+ Mnnn,r,e 823=71LW'—
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<br /> Apl'licant - Return all ropias tn: tinvir.+',r,",•1,'I 1i'u'1t+' Poan,if/$arviCea 1601 f. Horolta nvn., P.O. Box 2409, 51k., CA g -'l
<br /> nATE
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<br /> I •,^.(flrrn- R41T_T 0 tfCElVit)DV _ 1
<br /> t°E'r AAtI?VN1 nt?r p CASH
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