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<br /> FOR OFFICE USES
<br /> APPLlCmom FCR SANrTAnd
<br /> Woo In Trlplkot tt:Ne,« Y FI\1
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<br /> ... .. This Hermit! Mlres 1 Year From Dale!riyed
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<br /> A lkatiorl is hereby a,ocle to the San.Joaquin local Health District for a p nnit'tb�berfsMret and nstail+trK��verk liirilA
<br /> described This application is made in,cwnphana wqh County Ordlnonce No. 649=and extstihp`Rules`'artd
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<br /> Owner Narne .... »_.....aa.... ,,.....�'.Ywtis..Mi lay. w` +....+N.....
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<br /> h, �YXFti�•�"$1S1k`"�'?M� ' .. ». ... j�r 4w s 9$�':iF �G -'^M, �,yH �y� �\ �
<br /> 13lnl lelliott well swrvs�, Reslder+ce'{�'i porlrnent HeuaC Owmerdol rifc�0lMf'
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<br /> � 'rat 1KW6 unitu.......I... Nun►ber of:6edraoms �...�. Gorbape Qdaclwr
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<br /> T2
<br /> to a depth of 3 heh .Sand Ort til►Q Clair ©• Aeat } ", *1can Crq►'�anRt
<br /> Y Adobe Fill rlllaterial... if.
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<br /> i ►mss ►inp'stre of lot, loeaffoi gi f:syslwn'tn n�iatlen to wells, buildirq�, wls,MA# 4,10 few
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<br /> fiAt�4GNr (No septic tgnit or see pit penmhtid if Wk' saver ka Aolife wil�iin fiirt,�`
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<br /> No. oflinws .rT» � wdah Atte ::Sf, irR.=.Ya .r..�ww� '�r«
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<br /> 71
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<br /> Distant. to ttearwsh"iAfwlr ........ Fourttlatroii FP k �� 1 P
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<br /> Depth' .: «w N.\. Dlatter «.».»...».» Numlt�► \N.Y,. rtrtr. /d. a;�j NO
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<br /> jDww exlstirq and required oxldithxt nwwrse i
<br /> • esrll�I�t1mt 1 !raw prep"',
<br /> Ok opppoedoa Md dig* the,wwk�r���.d�,bsopM��i
<br /> j " ftNs Iowa ad ft**WA EIiwr* w"N tM `wvwpww wMwr ar'
<br /> " r that tM'edormance of thi wow ter*No ab peach h!screed.!'Awaril .y.:, ayry psi h iiid►
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<br /> APS(CATION ACCEPTED BY.... = .._.......... ,... 'P WRQ! .��Yl�.t .►.cif'�',?
<br /> BIJIEDING PERMIT ISSUED..........».....::.i.iti....\,....i .....»..............«:ww w i. ..".+...a.. .DATE �. . .M"' .
<br /> `,ADDITIONAI. COMMENTS»\............w....«ww_
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<br /> no Inspoetlon by ........ ........w.i.iiiiMLLM�wi.i,iNLiiDeft
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<br /> SAN )OAQIJIN MAL HMALTM Dt3;RIC; <'� �`'
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<br /> E.H.1.3 244 1-'66 Rev.SM ..}
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