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(Complete in Triplicate) Permit <br /> _ t <br /> Date Issued._� /.-- <br /> Ap /� �' �f and install the work herein described. <br /> Thi / id Regulations: <br /> JO CENSUS TRACT. _._...-_...________ <br /> .............Phone <br /> Ad .Zip. . -- -----. <br /> Co Phone- '- (---- -•_- <br /> Ins ler Court ❑ <br /> Nu3... _ ._ --------------- ---- <br /> WC � � ® -. -.. N._... . ,.._, ----Private F±�'' <br /> Ch. Clay Loam ❑ <br /> (Pl( / placed on reverse side.) <br /> NE' �(e within 200'feet,) _ <br /> PA _ _-._ ---L.iquid Depth.;_._-.....:_ V''' <br /> Compartments__ ...._............ <br /> _----.- _-- <br /> !7_9------------Prop. Line_,: a ------- <br /> - <br /> ------- <br /> ... <br /> LE/ Total Length.__.._._._.9�....:.... ........ <br /> ....Property Line. .._ ---------- <br /> SEE Rock Filled Yes❑ No❑W <br /> --------------------------- <br /> -------- <br /> _ -------._--------••---- <br /> ---- -- Prop. Line---- . - ---- - -------- <br /> REI -- --------- --- ---1 <br /> SeF ------ --- ------------------ <br /> --------------- -----------------•--------- <br /> I h 3ccordance with San Joaquin County <br /> On istrict. Home owner or licensed agents <br /> Sig <br /> „1 mploy any person in such manner as <br /> to <br /> Sig <br /> BY ... <br /> APPLICATION ACCEPTED BY _. DATE D "J- <br /> DIVISION OF LAND NUMBER__. ._.--------------------------- -,DATE _ <br /> ADDITIONAL COMMENTS..--- - ..__ . .. . ---• --------=-------------`----- <br /> _ <br /> ............. -- -- <br /> -_.. .. <br /> ---- -- . ----- / - --... -- <br /> Final Inspection by... __:: ----- - -- <br /> � !� : ..:.. ........ ... ...... -- Date. �""._ - <br /> EH 13 24 SAN JOAQUIN LOCAL. HEALTH DISTRICT fss zy�y'7��v. -76 3M <br /> I <br /> -'7 `4 Ar:..._ Vie.#. - .'�i:`�.tJ1� u�i'r'•i�Y��� .r'.�.. .7it' }.,3�.:..t. _.. �'t'.:`:._.' ,�:..r _..... T.. <br />