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FOR OFFICE USE:
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<br /> APPLICATION-
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<br /> Thisp Alkw1v Wilkz k fr
<br /> Ap ic+ation Locb1 Hi�lfh tstrkt fot,b rrnrt'kr C rirvC
<br /> hhsrebymade to+heSen Joaquin t ietia lei h�>'ein 'b>!d °�
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<br /> This applicMion is made in compliance with County 0tdim.0' Nb. $49.; y .
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<br /> Ownaii`?+ie�i;. ii r. a. Wtbt+ll» -
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<br /> CDntraCtOS'f Name.............. j r ....• TIIWi� '
<br /> oenrn*rci" [ '1jrr ilat Ft ourF ] Mohd �] Ofl,�r C3R
<br /> Installati i will sates: Residence C] Apartment House[� x ,
<br /> f rocttta Nua+bat aif baths tie-
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<br /> `f�'4 `N�►inber of living units: ........ Number a bed : • � ��
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<br /> 1111oht Suppers Public system Q Community tystan+
<br /> Q Cal Lobi!► �iiy� "Ado � Fian,j� �
<br /> I+iracts!of shit 4o a depth of 3 feat: Sand Q Green!b 5x44 Lobi+ y�
<br /> ? filo•�} Nilo ce til s Yet ,'fe>1( No Q +.
<br /> pNiiriaei"", pl c;a*>i Mad*: i1f yes.date..............
<br /> YPf` 1145TA"TION Alii: SPECIFICATIONS'
<br /> sawar is 444abta,w Ift I�DO ,•�,� - ' .mks
<br /> xr -0a disk or aasspool p*rmithd if blip {N bls�enc n >ftxi l �"`_
<br /> lint: Distance Pram nearest wnll.....
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<br /> t« .� -No. of compartments.............. Sats r
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<br /> isp -old �' Distance from nearest well.... .Lon fief+ h it
<br /> "" WWitrY� rot�cF� x�,
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<br /> Number of lines......... 1, Total
<br /> ;� rA rYPe of Filter meTariai........... :..:.. apth"oir fti�rYtietw : : t;b.... �..
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<br /> �ot4 l��statice fo�rityst
<br /> ;t :..'Distance to nearest well. :Dissii(t ` slhb mc' `; • k ,* 4
<br /> Number of pits................:.....i.tnln
<br /> 11.... ss bisti� �. fne : Lin�i+g µ V
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<br /> Air ntsfance from nearest we ` rice trgri'► !tan �` "„ ,
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<br /> 3. Sic: Diameter..... .................. .¢ p +^• ,gin,
<br /> x 8
<br /> �# �� yi.. �a y,,,.� �'`�y'♦� y is
<br /> L �f,�� 3'
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<br /> 1 Pei , Distance from naem + s� ,• � ieie4 :g:5 � � .�.
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<br /> Distance to nearest lot lintt .� «.
<br /> M� �iN repairing (describe):. .... c Y; :r
<br /> 'S ' -�.°�• .yes �.'�` $¢1 Sk'a�ta�'Idt.l >msr. _� �,�
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<br /> j� 1 have prapar*dtiki�ota�l aid�' iiLi Hi!lf,Dliiaf� rEr ` ' � `�~'
<br /> d rules *�� •A-,
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<br /> y of lett Io». .«....... caff"of.
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<br /> yr�t r1.. FOR 0VA1t"A_ _ - L ¢ m' `, i:..' t } ?, •���� h _�dl ., 4
<br /> Y�!•.R f t.' x _ .._ +f ��i�-� .fir
<br /> I+l°ptxAf1014 ACCEPTED BY.............................
<br /> ATE_
<br /> fREVII 'i!1' ..... ........................,............,,. �> c , •b/4
<br /> BL#ILtllFi43 MMiT IISSSwUMED........,l.�........ >. tP »° "« .�,
<br /> Altatila+r aled�er r*rarnan*ndatians: ....' ....>.r.... .................
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<br /> FINAL INSPECTION BY:...... .............
<br /> SAM.IOAQUIN L66AL WiAI<.`M bIS1KWt
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