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` rr <br /> y Y <br /> FILE COP _ <br /> 1oa OFFICE USE; Permit No. -iG..3 <br /> sa���l� KWt�NnaN PERMIT ,.. <br /> P , <br /> .f�;. ._.`........ �hiC betotnTd t{tale _. <br /> �... . <br /> ....--.-M.......................:..................._... Thisftnu. ltE*res I Your frm Deft Issued 1 Cats Issued <br /> Application is hereby mode to the Son Joaquin local Heafth.0isMct for a permit to construct and Instal) the work herein <br />'t deaaibad.This application is made to eomplionee with County OrdInance No.X5449 and existing Rules and Regulations: F <br /> k JOB A6D6SS/L0CATI6N o�.�. ... ._.. ! 4.1 �.�'�/ CI SUS TRACT S <br /> Owner'a Naim ..-�tl�' o.P..VrA.... !rf.R.�"{. ............. ......................---'........-Phw+e <br /> ¢: 'ice "!"'! f . <br /> Addrasi ...::--. ....................... .. ........ . .. City . ... �: <br /> tractor s Name g. :. n. ! ...............................................license* ... --- .• ...... Phone .................... <br /> Inittcflatiatr tial!)lei sY ResFderrceZApattment Houset]Commercial.QTrailor Court C) <br /> t 7Yy: Motel❑Other <br /> �4. <br /> - t <br /> dumber of Ihilrrg.uhitar .. __ Number of bedrooms ...3.-:Garbage Grinder 'h* .. lot Size .. ................................ <br /> `Water Supply,PubikSystem and name .........................,....... .__._Private E3 <br /> A ei stili to a depth of 3 . 'Sand b Silt[ Clay © Peat 0 Sandy loam C) Clay toamjS,,. <br /> r . <br /> Hardpan.© Adche o Fill Material-__...IF yrs,type............................ <br /> x `' et ►fon. sha ring slte of ioP 'location of systom in relation to wells, buildings, etc. must be placed an reverse sire.) NQ <br /> :',N iIF` AI Ti le, ft septic tank or seepage pit permitted if public sewer is available within 200 feet,) i <br /> - h V <br /> PACICAG>:,TREATMENT + SEPTIC TANK() Size... 1 C.�.nn'. i�:.. ... t squid Cepth .. h�r ............ <br /> Type :� Matariaf.:.C�R •i+G No: Compatwonh -..a�._.•..�..-.. e< .k <br /> i pinnae to nearesh Walt ..........:.........................Foundation ......................Prop.Line.............. ..... i <br /> U .lfpiCN1Ft6'iit Na of lines . .............. length of iF -�_-•---- Total tn+Od+ __ .......... ' <br /> f r <br /> p I3 Bair : Type FFItor Materia Depth Filter Materlai __.._.�_ .................. ...........•- <br /> Distances to nearest: Well 4 ... o... . Fourxlation 0............... Property une .>S. ...... <br /> 0 G'9. "��j _ Depth ...A.5...... aiameie1 ..33'... Number ._.....44...........� " Filled Yes� No � <br /> .. J` <br /> Water.'Table / .....Rack Site . _....6.....a........ <br /> Clioance to nearesh Well .. ...Fosmdatlon .................... Pirop. line ...................... f, <br /> AIR/ANXIM 1". Sanitation Permits_............__... ..................... Cate ..................................I <br /> a � 5eptk Tank (,Space ji Rsquire�rsaMsl ........ .................................................................................................................................. s i <br /> �. DispitiCl � fY ,ItsquFrementsl ..................................................... ......................,...................:_........................... <br /> .................. ....... ............................................................................................................... R <br /> ..... ......................... ......................................................... <br /> Asa , i :; ; M �s S'f lt�l�Ilf exlsttng arrrd rOgt4rsd additlon on reverts%I&) <br /> v <br /> 41 � �ifi,f Ys ISM tilts coptleaft" and fho* me we& VA be dere to sell dW to vMth t�pr''1s�sgglrr r <br /> r' <br /> y r [t s;p tr►hs�ws;Aird glue aald Regoil rets of Nee Serf Jetrlrlit Letd Iteahlr C[swtd.l'fstrte owner M Raw a l <br /> "1. lt $ Ire Apar of tlrr vwerk for *b penMr M iaaed.1 :M0 net sari isryeMn M such lstesrrMr <br /> �+eai'te ' ' ti W Irsws pl fst+femim" <br /> .w............Owner <br /> ............:»:.... Hie...:.......... <br /> {If cilli#than awirei4 :.. <br /> i ArKM�R Un ONLY i <br /> 'APPLICATION'AflC'EPTED ti " • ........ DATE ._.. <br /> �Ui INO:Pt2tJMt7,iSSIJED r 1� . t)I1TF..................... .... ............. ^ <br /> ,ACDFONAI. CGMMENTS ` ...1t���''.. �!'(p= !./r. ......................................................... <br /> ............. .................................................. <br /> ....... _ . _R K..w .... /.... ............................................................................. <br /> �. i. ♦.... ^, r............................................... <br /> .........I.......•....... ......................................... <br /> �..r.........y....,/... ...... '. <br /> E f•llr►ai Fn`pecffot+i'1 n sy ? �[-1.•••.. »._..._.. ..........................................r..:Dotf .i�:��/.L.:: <br /> SAN JOSOUIN LOCAL HEALTH DISTRICT <br /> i H. 9 1•'4+8 Rev. SM <br />