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<br /> FOR OFFICE USF-
<br /> APPLICATIONImo: SM+tITATION iPRMIT
<br /> ;:.. Permit No.7ax.4X_8
<br /> Date Issued ' � , "
<br /> --._ ....... ..................... - This Ihnnitexpires I Yeerltrern DeftIssuerl 3:..
<br /> Appcation is hereby made to the San Joaquin LocalHealt r�GiStnn for af'"fi�"CtH�s�tt�ittvnd"lnslaN'1he work hen11n
<br /> deso'ibed.Thi application is made In compliance with County Ordinance No. Seg and existing Rules and ftsigulaft1w
<br /> JOB ADDRE§t LOCATION .....15151-M...�..Harney.......................-.......................CEhlWS TRACT ................
<br /> ....................Phone....462t�41o..l ..., "
<br /> Wit %,ne ...J1a�..-MCGee. .............................................. a
<br /> Adaas ..32.�fi..E Main.............................................. . ..........City .......Stlm,*....._........,............_ ................«..«. a
<br /> CoM ctor's Name ..Pla ckard!.s...Septle...Tank. ..License#
<br /> Instc lation will terve; Residence®Apartment House 0 Commercial []Troller Court
<br /> Mate!C]Other................................I............ �*
<br /> Nutt of living unitstl......... Number of bedrooms ..3.......Garbage Grinder ............ lot Size _...100,_
<br /> Wat r Supplyr Public System and name ..................I............... ..._........................................_.......................
<br /> ...._Private® ...
<br /> -thatof soil to a depth of 3 feeh Sand 0 Silt❑ Clay ❑ Peat❑ Sandy loam ❑ day loam 0. '
<br /> Y # � Hardpan® Adobe ❑ Fill Material ....... . If yes,two............................ r ,
<br /> `4
<br /> etc. "must be placed an re ra side.)
<br /> fan, sing sire of lot, location of:ystem�in re')atiori to wells, ulldings,
<br /> " TIDN:
<br /> (t 1,j
<br /> -tic tank seepage pit permitted if publ sewer is avallab.e within 2100feed ,i
<br /> ENT l j !C !t. a
<br /> Ud Slza..... !X X14 ... .. ...:... Liquid Depth ..:.liffi ..�.;
<br /> 4
<br /> ;XCaPocit Type $ ".-._._. maws -Wmolrele.Na �%"'=-• �+, q
<br /> to at, II _ ..................... Foundation ;:.P.A.s ......Prop.Line.....3.Q0.
<br /> z ." s Total. �AO
<br /> L841gth ... �..«
<br /> aJ LINE , No, of lutes': .. ................ Wgth of eadh it LOQ•• :. } _ - ,
<br /> 'D' Box ....:,3.: Type Filter M t+erl a"........ Depth.filter Mate I. .. Q..:...............s .l� ..•..d� � a
<br /> Well
<br /> .-found Ion Properly Line,....
<br /> Distance ro rash f ..... :. .
<br /> Depth X5!..9...... Diameter ..... �".... Numt - Roc4c'Filled Yes ° 11
<br /> {. Water Tabu. .........9°............................ b.F..
<br /> s� h •..............:,J +tui _t »..gyp, Una :Z
<br /> _ Distarats to Malesh Well .......... . X30 �.. . .1 � .
<br /> ' AtD�Ilt4lwl(Prey. a•nitation P"It .. .............................., _.... .ter....:..........�.......)_ '` tea,
<br /> 1200
<br /> ` �9pecify sl al! .......
<br /> .... ..:.. ... -�Requirenent ± -i +FW;Q (Specify RequieemeWSJ�.. .. ..h.1 33�
<br /> ...........................a............ aa..,... ..ia
<br /> J 1.L �,••1•TJ r'4�. 'R w R . ...... ................. .....a:...a..... i ... ... : as ..�x.• �..wwY�',��
<br /> .(Diawexlstingrattd required additon on reverse side)
<br /> t ,�, 4r;q
<br /> j�.}'I ►y ttrat 1 have pr.per»d tlds applkaHon and that the work win b. Flans ter .reseeraaa+te'r.ith'>Ilprt +detFy +
<br /> Qtdltiarzas, stars Laws, and aviee and Regrtlatlons of the SM J�v1ri Loea1 llenith Dishtd.`liante enNV�er =r+
<br /> �.a��, "sIl�natrrre certi8ss lhelsltsvrinpt.
<br /> p
<br /> trr the poritwmance of 04 woelk�for wench this perrrriT b iswadr 1 shall not etnpley stallPont" In 6A 11861
<br /> to Werllift 's Cseerperesarlor► laws of Cagfoneta." w j • `"
<br /> ` ykay Selig.,LY A!P . .................................r V�►i�f y 1.
<br /> r + .. ..:........ Title..... t' :• ,
<br /> thon owner
<br /> r. 4;,. • Fo! DE►AILTMENT LiSE DyLY�,,,,� �-
<br /> f APDL TION ACCEPTED BY r . . _.. ............. . .... ..... DATE_�`��'�T�r .....
<br /> BUILt11NG PERMIT ISSUED............... ........................I............_..._............ DATE...................................
<br /> .....
<br /> 'ADDITIONAL COMMENTS..... . ... ........ .. ... ........ ....... ... .. ... ....: 4,
<br /> Flnalgnipection bye t-�Ltr-.. .. ....................... ........�.-........... ...............gate.. lr",.� •-, .. x.._. Viµ,
<br /> SAN JOAOUIN LOCAL HEALTH t
<br /> T.H.9 1•'68 Rev. 5M
<br /> " .M , i�-,�•�.�a.�} '"""'.""' -.. �._..--.�..-..._.... �..,_....,_�...�M...,,. . r.. ^^. riy, �.k�.�,�=�AG7'�i4�i�Tf�sY�"a�-��'t1f:' - _ t
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