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<br /> ppileation-(s lore ma•1e`tel the Scn�Jaa ''
<br /> � y;. t �,, „ � gain Local;Hcr,ithtaistricr Earl a permit�to.construr7rar►cf;�Inst cl$� T
<br /> deccribeyd ihii,appfication i=. tnm Ilapre„Klfh"Cot�nt Ordinance.No}5 and Oxiititt Riifat'd d�R Cul p
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<br /> nstaltahon will sere h4 r t ❑ p F �x fl ff1
<br /> es - once ;4 8rtment House ...on,mercia�Tralfer Court���]
<br /> KA, Motel Ofher 1} Put1f lyingtVnit3 t : Number'of bedrdorrms x Gtirba a Grinder LatSise �7 tr
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<br /> P10 lort,�+alioiiv`,ngt sr a of iot,v latation of system in relat(on to wells, buEldings etc must b�i�`plao d o t .4
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<br /> Distancelto neorest Well y-, ,L 3- FFoundation � ,t - rope tree ,
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<br /> btxposal Field (Specii. equiremrnts] �
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<br /> �� t L`� � (Draw existing and required addetron on reverse side)
<br /> I'ereby certify that I�leave'prep r'ed osis app,0ication"and that the Werk,wil! ba, one irl aitcera�lni• ' th.Smt dos ' .
<br /> County Orainancas 5tateFlaw:,land ltufes and ftegulatfons aF'the San Joaquin local Health DitfritfHsmewner oltgih•
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<br /> s�tagonte sIgnclurr ceriifIes the fo110 { � f ' f
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<br /> yt,�cfr►afyfthatiTn erformonea of the: r penit Es fisred 7 ihall not employ ciersan n :us6 Nn n11
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<br /> Title'
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<br /> APPUCATION{ACCEATED BY ,r-
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<br /> AOD1TICrNAL COMMENTS r � l a bad: ., �>�
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<br /> ]-Ei lfcv , SAN JOAOUiN4 LOCAL HEALTH O STRICT 8ITL �3M��garW �� r
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