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FQR FFICE LISE
<br /> �A
<br /> r w +. S` t r Permit No. _.�..Z -•�
<br /> .... ...... ............ .............. f �l'���..1,..•A'�it.a�� t t7i? ��f�!i7r;, : .rs.IvttT. �-•
<br /> (C npiE*{» m l?uplil-M Date Issued � !
<br /> !_ . ..__ ....- ..... .. 1 This Pvrtnrt Ex!:'i'`oi i Year Iron) tssuod
<br /> Application is hereby made 'o tho San Jorquin Lacai H,%,.-!4h Disirict Tor u rx' .nstruct and instrli the work harem dasc bed.
<br /> This application is made in cc•r,piiance with County C7rdinnnce No. 549.
<br /> JOB ADDRESS AND L0CP,T1 0N..Er./".r. . ..... 1...........1....._ o. .. ...
<br /> i Owne�'s Neme-.. �... A.. _. 4f .9 1. _ .. a�._.... ..... Pon»..���.De....�.+t?.� ..Q..
<br /> _ 1
<br />_ n hddress �_.�!Q. .1 �p / a. --''' ... _ 7► n f _.. .......... ....... . ......_.
<br /> Cwfract•ar's Name. .•--t— �"If.. ........xf. r.. .�...A..
<br />» ` Installation wM scree: Residence A arFment House J. Commerciml i court �] t.'.c •I r�7 Otha� ❑
<br /> Number of living units: .?... Number of bedrooms I.... Number of baths i Lot site _.../�.'� n _Z � .. {
<br /> Water Ssrppiy: Public system n Community tys!»m 0 privateff
<br /> i?epth to W'r.to Table . .
<br />'{ Character of soil toe depth of 3 fort: Send Q Groycd -1 S an,:y Loam❑ Clev loam Q Clay CJ Adobe 0' Hardpan Q
<br /> 'taw Constr,.ctian: Yes No [] FHA/VA:Yes❑ NO
<br /> Preview Application Made: (if yes,date......._... .
<br />:h TYPE;4F INSTALLATION sN!:? SPE-CIFICATIO!,:i: >
<br /> s�
<br /> (No sepVc tank Qr'CdSf�O•nI parmittr;d if publk,sewer is areilshI w'!11i1 00 fest.�r
<br /> f!.-..._._.Meter16. f'r•oel7.
<br /> Sept Tank: Distance from nearest wel ..f5 .....Distanr frac foundof'on.• t lLoO _
<br /> No. of compartments.......A...........Situ�.J....... ...Liquic! da{�th....`7�
<br /> t Disl~M ai yield: Ctisiance from nearest well..4 a.......Di+stance from found,
<br /> tion..../- .. ._..Distance to nearest lot erne... __,,.. .. .
<br />:1 .. gth of eac
<br /> ren h line.� ?...t .. .'l/.._.Width of trench......
<br /> Number of lines.. Y G�
<br /> ury type of filter matoriel..,ts+t:.- C.__ Depth af,filteC trrterial„_/. ��.+.r..,-Total lengtfi..._...1. Q..___.._ _..> ...
<br /> y
<br /> ,�
<br /> At
<br /> Se�pege Pit: Distance to nearest well... ......:Distance from foundation..../d...__ _Distanc c tc ne.irost lot
<br /> '•t ( Number of pits %.., I_ininct rt atmr;el... ttt._! ... Sire: Diemetrt....�.�.. - ._-.Depth.....t,
<br /> e
<br /> r'
<br /> Cesspool: Distonce from nearest well... . . -Distance from fourcintion_.. ...•.__......Linin mat riel
<br /> � •rF Sr:r: Drnmetar .....Depth...................................................Liqu Capacity..................
<br /> }
<br /> 'j ry Q G;3tenrte . ,... .....,. Wrest building-
<br /> Privy:' Distance from nerext w4dl_ .
<br /> r��l '. ' o.... ,, ;, � .10. n-3a
<br /> ftamcde;n� end/or`rtyi>airig ('`'r
<br /> ............ _...._..._ . ...` ..........-.,I ..»...__........_....__......_..... 'i
<br /> 00,
<br /> w. 1 s.......«.........--.� ......_...»...... _.......T.r......................... .....-... ................ ',
<br /> �f i herefn� eertify that I AVO I„YstooquW
<br /> ,rrs,d +his nrrplitot+ext rare! Mat the erect MNt kis dont accordance with San
<br /> i of"UPn 4 ttte Ijwx, 'rules nd r,:�tF1�Ytit�.s of, t :raj5.os in Loeel Hra{tk Dif f-
<br /> ' r/ fir"', �;� (�✓ .`�'
<br /> ? .reSrt .. P �t5 t ti ............... . _....(01rrIPr►and/qt .� J
<br /> (Sign 's J{ry �- _................_. r .... ....... ...... ... . r . 7
<br /> 't ... ..r .., .`+I ��,......tl.. rr+.. . .... .•1........ r .i.,...tii :S, ',
<br /> iq ° t
<br /> (Pot .s q si!oi'of W. iocaticrn et'system+ in•erla on to.r ok,bulldings, etc., can Mr plabd on revetar;ideJ+~ r i.
<br /> rt9.6% iw =FOR DEPARTMENTUSE ONLY �c
<br /> �y. -�a,�`' ,� _A DATE.... oZ '-•�. .. ''
<br /> APPLCATION ACCEPTED •tY c.�.d'.......... »......
<br /> .: DATE.._ ...... ..�;
<br /> REVIEWED ;8Y ......,._...,......,......... •........._
<br /> BUILDING PERMIT ISSUED. .... .,. y .... DATE. _........... .'-r.- ..i--
<br /> Altersttons fed/ex .. ... .,SAF
<br /> r ...
<br /> t• ,'.. -r
<br /> FINAL INSPECTION 8 :. .d .s. ... .. .................. Dete.... .....1�'.�I!. ..
<br /> -0,i JOAQtIIN LOCA
<br /> . L HEALTH DISTRICT
<br /> -i t, ;•
<br /> S 1601 R.►4epPtiM Ave. veli 0M,Strrs9 `l 124 SYcr mete!Neel 205 West•111 Strom
<br /> '�i r. {PMPrIiA,I:NIhntPr. •� '.'u7tPnrn bn ManNte,tali/erMFe' 1raRrP.Calllu^Ml- V i
<br /> c• • Acvuco o-e• LM 3••a2 r.•u.
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<br />�I "�ilih�;laa1'ftllt,.<.�ixTntl�s..:✓.:n�...a `�'-�.,,. -. ��..., .,. '�r�r-• - �- -•.Lt-
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