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<br /> H4 FOR OFFICEt1SEf •'� r i
<br /> APPLICATION FOR,1%&MAYION P"IT
<br /> Permit I+la,. � _ �
<br /> ... ... This lartrilt ra? Yrdr ltrant aN Itswd Dat lnrwad ..-.... '
<br /> .fi AppliciA6h Is hereby made to'the San Joaauln Lova!Health Dlsh for a perml! to,;tontMkt and (ntfalll tlN.work IhnrN r.
<br /> V deseribed This application Is made In compliance with County , inane Ni. 549 and.exis ing Ruin and Requ�aflfMtsr :.
<br /> JOBADCRESS/LOCATI .4... ..I. . yyt ►►. ..... ...CENSUS TRI1C!"/y it
<br /> ............... .4
<br /> .'.r::... ...... .« •fr �.l..I��. �+.+y��-x'P�f
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<br /> °y Addross'f _.`:..
<br /> Coaitracinr':Name......... �!1. .... ..........«........»lianfW f/v.7. �.!'Jrani 7i .�f
<br /> �a ��FInetallatlon will ferVec Rasiaena p AporfineM Hous Q�Cortlrrini W[,'Rrailrr
<br /> � umtiir of livinq[ nitsf. Number of bkkw mfi �C3arb* Grinder....« t-10 5�
<br /> RAM
<br /> ,WcMrk 5upplyt is system
<br /> gF?Cbharader sett t a'deplhf het, Sand❑ Clay ©' ©' SW►d1►l flr: Gal►Imo+ 7 Y
<br /> /"��IG � ur - w'��y�y �r�:. yF as:.''�•-' '-, '��
<br /> A�.•,r �, i`p�s a . '..aY..r' bill l�ater{a�+es+tnrw..l♦�af/•!� w� ...,a,, +i''
<br /> `i'+ y '
<br /> g(Flom plan, honer4 s$ra of of systemIn as all an
<br /> -''NVW INS1lALlA iNq ` cw seepage.pN is awstfable fiN t x
<br /> !}ACICAGiE TREAT J Y f fAel, .
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<br /> nft Wau
<br /> a� LEI1C 11NO,LINE No'Aof Urtis i errRth,6f ! `* :: Totol
<br /> ttf,,iy, � �S.E.TE, '.}'{'�'•F* ''� r..�l f; �#p 1 1_ ... tu .y - .'S • // �e `. .IDeny ptRTYpFllfer Mafariai jTle -� + UM
<br /> sh Weil :.tP"l'q1rreo� s..N:.:o:..a[.".f..['
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<br /> PAGE PIT" Oarnee6 Rok,"Id
<br /> Wat6r TaWe�Dtpth`. .. / ..• �"'� ;d;
<br /> DisMnoe t0 nearosh'WQIi �/.. �' ° �OlJtld�tiatl J ` �Mta "�"'f a
<br /> i jib 'g,
<br /> �1nw vy "
<br /> lTkk(Frau Sanitation.Permit
<br /> r i�Sdptic Tank(Specify Requlrerientsl..`......................41
<br /> ..«..«.. a »...•`` , wr....J,....{�,; +
<br /> Diipc�fial F1eld,IS�cify Requirements! ..............:.. --.. ...... «....« �.. •i �r ....::.' ss
<br /> Y .ka&,�+$,.f •[�4r` 05}.� F_y :u
<br /> , „°vr ,x it } a z as
<br /> (Draw existing and required odditldrl on nererss'side) , � FF
<br /> I hensb' eerttfytthata Iraw this tatbrt and that.•the Werk•w111�be"eiene 1n ea[Mrderses �ritls iJeMM�
<br /> n y Pr!R San tdn I<eRal Ileablr# y � .
<br /> ;,�i[COYuit��i!'larltls�,Stbh LaYI►Si qMl Rules and Regulaftons of the' �Oflfl a�1lIIM awnor,fta�gll+
<br /> s% E- s�gn1
<br /> 4 th
<br /> �; ;sed a9Nrts natirro efrHfle foliowin9r
<br /> F!!GnrHfy.;that tffr.•1hi piifd4i,"of the work for wm h-this-peradt is�lfrsired,I shall Nof irr�lell►esty 11100MM itt suds rtssstnM S -
<br /> '`k.,.r-f +{` s"n"v"�," s N t-'....r _ i qtr} �„ 3` �K•_ +'r
<br /> ','� as ro bieon+e sub(ed to Wortcinan s CeerpensaHon Paws
<br /> of Gsliferaia
<br /> kit;�$�.+„�{- ror.�,� �,Jyt�» Pw �+a+e •wn,r? � a � g:; • a �,-*� � t
<br /> y Slgnad Own.,.
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<br /> If of t nOWr1!°r� -,rz, .. .
<br /> ✓A" } ��'r"�,r -j'd
<br /> FOR DEtAX MMS USR QPIf.Y
<br /> APPLICATION ACCEPTED $Y; _' :.. .:::..........«......:..... ... ... .I]ATE .t '..` y fis
<br /> .; .,BUILDINWPERMIT ISSUE1 ..T: .__...._.... �. j
<br /> • S.
<br /> "ADDITIONAL'COMMENTS ����.••-...•
<br /> � r ........................ ..... ................
<br /> Fina}Inspection by:............ ................... .. ....,.._......_..:................... ........._.---•. .... .
<br /> ..
<br /> EH 13 .2 • ,1-68 Rev.`,5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 314 �j
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