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FOR s7�lcE,usE <br /> n APP6tAMN FAR SSANRAT*N PERMIT Pamrt No. <br /> 1Cem0e% Le NP108 'j Deft klwnd <br /> Thin paawit <br /> bok" T Year ham Daft Lewd 1 <br /> d pplipfion is hereby rnsde to tfle Sen Joaquin Local Health District for •permit so camota <br /> st arbd ind"Ma wa4 heew <br /> emin drbed. <br /> TAis application a mode io C�npkiaKe with County Ordinance No;519. v" e 114, ` <br /> JOB ADDRESS AND LOCATI . /` !U.7!U.7 -�/4'� <br /> Owtser'f Nerve ° a e,� � <br /> Address _ _. ...... _ .....,._.__.._�....�. <br /> Co,•+«tors wm. `L f r._I/. . Ma� _. ................ .___ . MMn ;Ve—IL U._, f <br /> lmtaiafiea tri oases: Res;dence ®-Apa ~t Heuw Q Comme mitIl Q Traltir Cant ❑ Mold ❑ Other (r iar-c--� <br /> Numur of living vn:ts: Number of badrooma..a. Numbv bofhs'l�. Lot sin <br /> Wates Supply: Pubic sYstein Q Co smvutnay sys14m ❑ Priveto eDD" to-Wow Tabio4mL ft. <br /> Character of wil to a depth of 3 Feet: Send Gro rl Q Sandy Lwm 0 Cleyl►aam ❑ Clay❑ r Adebe Q NW40M O <br /> ►reole viApplicetioo Made: IIt yes,do+e ..1 No Q Naw Cam/rmciion:jYas Q No [�FHA/VA1 Y•s Q• NO Q'_ <br /> TYPE OF INSTALLATION AND SPr0&AT15 S: 3' <br /> (Ne 14,04 took of Cesspool perw4 ed N pubic www `al ovdawit arlfhb 100 fief.) <br /> Stp ...... I M <br /> .. Hatak.. <br /> •; «n•ence frprr eeeell w0 ..Distance from fawldalien <br /> compammenil Sim_._.._....... Ligwd dep6h................._. CaPaciN.,.__,...,».,_,.,.. <br /> Disposal Ffld: Jis-once from noo•ast well .+C Dipenco From loundetion ..,;!d Distance to nearest tat fit,*. <br /> � <br /> Number of lines~ Length of each GM.. 7,:;-, ' W,dlh of Hench .,7s/ .. . - <br /> i r <br /> Type of f;:ter mete•,al.. .dc,k DapM of fi1M.r meseryl.. /.F Tote. IengrF . . ...,�...pr.,,. d <br /> S"P" Pit D:stancti 10 nearest WON, Distance from foundation, Distance to roomtket line... ..,. <br /> 13 Nunsbe• of pfts __ Lining m4te641_ .. .'.Sae: ("tee.. _... . ._. Oaptb„ ._...... <br /> Cooped. D'stence Cron nearatwaU_ ...Dnfenqm�ar <br /> from � Lining metatel.........................e,..,.,,.,, <br /> �U <br /> © Siea. Die,seter... .-_. .-... r....DepiF ..-'` . .. \,. Liquid Capeedy....... <br /> ........gals. <br /> f�Oriry: Distance from ceerwt well. e. . . .bhtence from Merest buiidinq....... <br /> Q Distexa to nee.asf lot lino:_-:.:. <br /> RomadeL^g and/or repairing Idefwibe):.. __. _.... ................ <br /> ._......_.. . <br /> 1 <br /> t• <br /> AWAt,Y cwhfy the I h&we - _e _. ._.. <br /> 3 prefrared tA�e aypliufron and that tAa>:ork n� bo doM in accor/anca .itA San Joagssas County <br /> OrdiMeGy. tah 1pw� and odes and re"latiom of the San Joaqu m Lxel Hee% DW#cf. <br /> . .. . �' nd « Conhaef« _ <br /> (Mot plea. sbaarip Cis let. hog" of s � de.myr�elahon M oa r�7adGe' on be }.... _. . . <br /> By . .. d lc� .�ftrs.. �..i6L1•. rNe <br /> Nleod a• reveres ode} <br /> - FOR DEPARTMENT USE ONLY I <br /> APPUr-ATION ACCEPTED DIY _0 'DATE. ..I t --6( <br /> REVIEWED By. <br /> IIJILDING PERMIT ISSUED-___ _.. _ ...-... .... _.........._.x DATE _ <br /> AMera/iom and/a raceirmneadothma. _ ....................... . _ ..,._._.—.._.._.._.._--......._._._...._.......__..---._._....._...- <br /> _.. ................ .. ...._..._ ._ .. ....._. _. _.,_....... ._........__.._ ..... _.._.._.._._._....._._ ..__........-. <br /> //-1.3 -6/- <br /> PNAL INS N BY,-0? Lv.. 7e•a� _._._........ ............ i <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1I4 Swr•A Iuww.arn lb..r aw W"psi%nw 121 5,4w *West 201w.• snow <br /> lM•Nr. 411hn.r (VI.CAMAW-w MraHa.[�INwwia i.+ry,CaWa.als <br /> .a . u.vm • •• •r �.0�tu� <br />