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f •Me OFFICE USE1 APPUCAIION FOR SA}IITJILTiON PMff
<br /> ..............,.1,V
<br /> .. ......... Pwmlt No.
<br /> - � Its1nP(tta in TtlP:llmll►1 /
<br /> _.- -.1-1. f_ this Prink Minn 1 Twee float hale m"md �+Issuod �?l
<br /> T_ 0t7-24v— 07 .
<br /> `Z pp ieation is hereby made to s� wean Jeatwia teoa4 Hearth bistrit� for o P�Tr�+I! to tar,sf*uef and i tmo Ow wank Nwn
<br /> dew,bed,This applir:mt oma ittfroode L+gW.PEionce with_County OT01hi ae No.ug and feirliviing Rates and'RawAsilansr
<br /> JOB ADDRESS/LOCATIOd! '.:`.•tea•.�r, � ica_.tY+.+., s.S.l __lEENSI TIiAC �_
<br /> .._..,............
<br /> Owner's Name ......_.. /.. �►+ t.Cir... - f,fit. ,.. ._ ......_..............,
<br /> Carmoitar s Tfarne_:.. yiQi Vim.•... .. +� - _L�e . : .... �-.. �..,
<br /> lm Iciflatlon will serve Res6de We "Mont Housea 0mnmerti0l 01railerCou" ❑
<br /> Nnmher of'living Units----------- Number of bodroorrs2__._G,atha5e lotSiie
<br /> Water Supply.Public Swam and name 1 J4'
<br /> __......... .-..._,._.-•--------•,.._...,...,_.....�,.•_..----__...-•-1111•-----•---:,..........F4imia/
<br /> chafamet of sal fa*depth of 3;ee►: Sam Q S&O Clay ❑ Peo+'a Zor4v Leah+O Cbl roar^Q
<br /> l4dobe I
<br /> ""pcmm0 iia'lafor6a1W4.+,
<br /> rifvas,fl'.pf7.__..................-
<br /> IPI*r plaik thorrif#g size of lee, tacatioq of system In ihn so wehi,huildings, air- mwt be p ted an tram sk4.1
<br /> NOW ROTALLAMONs qNa septic sunk or seepage pit permitted if puNic sewer is available within 2W feetJ !
<br /> VACKPt4 TREATMENT E I SEPTIC TANK
<br /> �i• � Upuil
<br /> Capoety..)J-0. _Type 6)� Ma� le_
<br /> Canpariniartts .Ci ...., ...»
<br /> Distance to marrst: Well ------ r faundativn- _-Q -:-•1111-•-Pray.Luse
<br /> IEACNIIVG EINO ( Na. of lines .---. ,--_._.__.. Lcngfh of l-yeans sir4a__.�OQ _�i :. Fatal iart6llr C7.....
<br /> 'D'#sax - dSType Film Material , *►.crlc.._.1)epth falter Materiai __ ........:....._ .............
<br /> Distaesve tneaeass,wolf«. ,l 11.11---formdar on L?...f.,_._.. Property line . ✓,..... ,..._
<br /> SEEPAGE PIT Oap+ ..�:t,,...�biaraetef ' mumbo* 1111._ Rade Flllsd Yas� Na Q
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<br /> ward Tolbla'Ocyrifi --•---------- Slee.i.fz-1�..�4-----.._.._
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<br /> Dlstar.w to ntorust:Wali__-.J.-Ct'P_l...1111 .�.:..... ..'Faundotian ./.!!-t_.-..:.. Ikagt. 16,e ...---------_.
<br /> 111E1PANVAf1lJfT10 (Prey.SonNWion Pmtnit#.__.-__..._...__.._'_. ..«..,.........Dose .......----------------_---......1
<br /> Septic:Tank(Specihr ftqukaments) •....... .........._._..,. :..,......,.--•...---•.--................ ._....._:_..,.. -
<br /> Dhpoial Fliald [Specify "u'trernmtsl
<br /> ---.._:..:...:.:::::-:,...,,.m._..,.......-....,......_..._._::...............-_..�-.....,.....,.._......-...__.1111-.._...
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<br /> ..-._..»..-....._._. -...--..-._..-.-._..:_..-......-..w,_-_._ ...,......................».,..« ..-.......,........:...«..,............n.:r......._..,_-.__._.-.----..1111_._.._...............
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<br /> iDraw asissing and required addition an reverse side)
<br /> I homby oeitlfy that f how prepared 011,aplaileallon acrd nkat the Wo& w1ll be dent In a;cwrdan[s wftlt Sm Jsnsgein
<br /> Gwnh[Ordl mmm State Lawlr and'Rv%s and Rem c+is tt tit*Tian laagpks f veal MMdlpr slider me ma awed or flaw
<br /> "d orm4s eigpnafuir tomfiiss sltr falimwlnat
<br /> 'I C"I"o that In ohs paehrnwrK a a♦NOW work for whiz%*% 41 VAI is howsd,!aha1J mat wmp%y 4my Te00"IA'WA wvwkfw �
<br /> as ft became ivbfe*to WorkmaWs SammisaNen hm of Cafilmtdo
<br /> ...,.......,. ...................... 1111 1--11111-1----,.,Own
<br /> By Jiel� •r.,d ....._...
<br /> - - 1111 __......_...._:
<br /> ql[atJtN share pi
<br /> O61f DlIPAteYMMY UN 6WY _
<br /> APPLICATION ACCEPTED i!Y DATE.._....'..._.....
<br /> BUILDING PERMIT ISSUED ..........:,._.... .......DATE . .. _.... __................
<br /> ADDmo#4AL COH1MEAiTS.-----... ................_.-_........._.......... _._.........,:.....,. .:..,.,. .....,....,. ..... .. . ..... ........ ..
<br /> T -_. ..„...».... _ ...,........... .. ,..... ...........i.«..»..
<br /> _. ...11._.11 .......... ..... .......�,...... _.,,,,.. ..
<br /> f;nal intpeeYian',by: __ . . m..............,...�.,.. --•---------..__....Date f .'_/.".'�Y-------.......-,'.
<br /> SAN JOAQUIN LOCAL HEALTH 09STRCF
<br /> E.N.4 I:89 Illav_SM
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