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Fitt <br /> _FOR OFFICE USE- <br /> APruwTloH MR sANrrAnoN PEM / <br /> . Permit Na. . <br /> (Co ph"In Tripikatel . <br /> Deft Issued <br /> E { I.W Pelalit EYpb"] Year From Dale Italsd <br /> ��rt Applkotlon!is hereby mode to.the San Joaquin Local Health District for a permit to construct and Install the wore hetdn <br /> �, described This applkmion In lion�Te jAri� Ord nce No 49 and existing Rules and Regulatiarts, � <br /> ADDRESS/LOCA " •• ..... >DJSI.IS .TRA�C�T} J� F s a : <br /> r 01Mrler a N€ + G? .... .....Phone <br /> i 'Ly;<'�Iddiea -3 ..:, .:..�. ............ . citydC ..l.i ...rr ._y <br /> e.:::( ? P� e <br /> d � �Cortfraetor'a <br /> . rtr. �Yr rNR�ilOfAfi Will NfY�i ~�� r>,pyte �W/f�..lrn/er+Cid!� rllef C&mr <br /> 7�„"�'�I--(M'a"' jay"`��t ' ` � :,_,` _ MOfW O Otllel ��IFM�'�r•�r�f...������ �r�:, � c� � <br />{ .gip,y Number of 1ivUsq Numbii of s�.: r.:Garboas Grinder ..:..... '!ot Sim . ......,.. .' ` <br /> F s Water Supplyr Publk System and nameJ. <br /> :.... ................ . ..._... akMale r � ` <br /> x Grararler of sail to a depth oft feet: Sand❑ .Silt Q Clay ❑ ?eat 0 Sandy Loom❑ Cloy Loam❑ ��? <br /> 7 t '•'" Hardpan Adobe Q Fill Mateilol...:.:......If yes,type-... . -; <br /> � . <br /> � s'lol� + shawl <br /> $ire of lot location of build"nps, etc. must be pland''an rw"i : + <br /> 1 pfat, n4 system in relation ro wells. # <br /> M{ I�M/ AELLA110Nr {No sloe took or seapa�e pit <br /> permitted If.publk sewer is available within <br /> 20p f+�tl <br /> PAC><AGE TREATMENT (} SEPTIC TANK{) Sise... �.�.� .. Id <br /> /._ Ory � 1 <br /> Wp�l_I .. ......•. yp L . 4L (w'Y <br /> I T /R6/.... MQhrial Na., Calllpart11Nt11{ .� r ti r <br /> .... :. <br /> Ridn'r ,y#n # s Amax QistanO! to neareati Well ............FOufldatlall_ Ll1M: ....�� f <br /> .. , _.;t._... .. . Prop .. f <br /> . LE/ICFIING.lINt; ( ] No of Lines .......�.............. LenQtlt Of lifts... ....... TOtal <br /> D Box Type Filter Material .......Depth Filter Material J <br /> Y h ,. <br /> to neafrsh Well y:.. Foundation Properly Lini s <br /> ,I�L1. 4(X2 . Number I Rade Filled <br /> Table 6MA . :::.......:..............::Rode Size':.. <br /> t Y Obtance to ttsaresh Well ............ ........Foundation Prop. LMs _ . <br /> t s R�AWADDIt!IOM(Pfwr Sanitation Permit f .................................. .... Date rj r = <br /> glpllTan!< 1 t utrenifulh) ................................................ <br /> C iSWc fy Rsq .::.............. ....... +F� <br /> 3aspow� Fhld jSpedfy Requiremenhy ............ _.. t sp <br /> ti *t °sr t r ! y1y T <br /> ..............1V ~ ................................................ ................................................................... .•. f <br /> ,�a �s a t° (Draw existing and required addition on reverse side) <br /> F ; <br /> (busby 1►: www oppoca"" x <br /> h ttat I �aYe, nsd:tl1la Olid�tl.at the�werk M�11 be sleae IA escerstasse �uhlt sssl ��. <br /> °• Casn�y► ttSMl1I awe° atiGd:Reles and Rewialians of the son J�agWft Low Heahh @Istlkt Ilsss'wnssr sr t1eM•' <br /> I ties iswino! <br /> 5 7r �• '> <br /> �B, cM1f1► Aloe Hie work for whish Mda perinit is isswd,1 chap pN eswpfsy aslr.peraersr M ewli r` <br /> '6„=`;ss ti Nfi' Cenipen fr lawn of CalHenita" h <br /> �'M Sip T ,< .. ..............Owner <br /> �X, F .. ° <br /> F e <br /> .. .71146 <br /> (If other than ownert pti <br /> ' fi ja <br /> FOR DlfOARTMENT-USE ONLY t p'• <br /> `J 'APPLICATION'ACCEFTfD BY.: .........................................4.. ......... .............. .DATE :. :t <. : <br /> BUILDING PERMIT:.ISSUED ........... DATE. . •4h !r <br /> c ADDITIONAL OOMMENTS ..................... .... .... . . h <br /> } ... Z' .... •.... .......... .................. ............ ............• <br /> 'f final inspection by° e. ..... Qat r ;. <br /> 1W`1 21i SAN JOAQUIN'LOCAL HEALTH Di$rR1Ct �� <br /> /7b <br /> z <br /> .��' . �'.+ar ,H3r�yR;:�. +•�4w:rt.a..s.+,...++r� .�+4-S.DQ- m�? `�7 ii;,�,y n( <br />