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FOR OFFICE USE.. <br /> APPLICATION 1=0R SANITATION PERMIT <br /> .. ................................... #Conspktilrs♦Tripllcatel Permit No. ..Z!_�:_2Y <br /> ............ .�. . r This Penult Expires 1 Yea `From Date Issued :,� Date Issued. ... <br /> # K Application''I-hereb 1 <br /> Is-hereby <br /> made to the Son Joaquin local Healtlt i r r t herein <br /> described, thIs applicdtion. Is 4node in pl' rete with <br /> € . Joe ADDRESS/l � - :_ <br /> OV ION ! lotions, <br /> Owner's`Name ..��/`�`ktra t�.. •� _ f. ] .GENS TRACT <br />! T. _ . .a:; .. .., ....!. ....... .Phone ......... ._ <br /> Address . :.. -�. <br /> contractor'st .. p ._ ...City ?!l:...:.. � 7.�?......: . <br /> Name . <br /> ..... <br /> Installation "o ... . .....Akense . .. Phone .TtP6:� 7, <br /> . . will serve. : ' <br /> Roslde 'Aparhnatt Nouse Q Cpmmerdal DTraitw Cotat 13 <br /> Motel Q Other. ..... <br /> Nwnber et livrlrs / .. . ....M <br /> t. r g unitar.. .1,...... Nu+etbar of bedrooms ...,��......G"c!ge�Grinder ............ Irof Sim . �J <br /> Water S .................. <br /> apply Public System and-none <br /> I <br /> ...... .:.......:....... <br /> i mil to a depth of 3 feat: Spud „... WWO <br /> •- <br /> .. t <br /> Character of �. Silt p pay �] Ptipt 0Sam L Gov Loan <br /> Hardpan 0 AdoFm <br /> r i t y s buildings, etc�aiwt l be played en rfrprse side.l <br /> IPlet plwn,,shawin site o4 I location of : stem in halation to weU:, <br /> P rA LLATION, (No septic tank or seepage, I r <br /> NE AF INST = t .Peed if pubs sewer is ovaiMbls witNn R001eet,1 .. <br /> ACKA�GE 1,RkME•N� SEPTIGiAN = � t.2.`: ...7�...,r. ...`. `• L{gvtd Dopth . ;Sl. <br /> .. d.. ...�.. <br /> ��-� Capacity .� 'Type ' „ <br /> : Nia11R 1..�'. ..N& <br /> Distance reser Well ::. a., +;" <br /> G <br /> LINE eat .•.Foundation <br /> r a nesXl <br /> ..0 , pry, . .: <br /> LNACHtN Na of Lk '2.1, ' !• <br /> i} Sox TYPe Fitter N�Cttbrlct `I�O. ...Depth Filter Auk" ... .; ..„.. .....„ x� <br /> Distance to nearest; Well ..��. .... Foundation . .l ?:`?`- L <br /> s1:EP.., € } p ....... #listraeter ...: w ° <br /> -- P• ...... l .• urnher ......... ......... .It” FINad. Yes p No C3 <br /> Water Takia De 1 ... <br /> ,.Roth Sias <br /> ©(stats to n" Mt, W611 � <br /> ._Foundation , � �, <br /> I1111WAIRI ITION#Prev. sanitation Perre�it# ::,. t...- .... .......„ <br /> - .- . Date ....... „� <br /> 1-Septic Tank#Specify Requirements).....:......... .... I ................................ .. <br /> Dispesal Field (Specify R.4ulremerits) ....................... .. ..... . . . ............:. ... ......,.. <br /> E <br /> I# ex _ .............................................. .... _ <br /> ------------------------ <br /> (Draw --'(sting and req"aired addition on reverse side) <br /> 1 hereby certify that 1 have prepared this application and that *0 work wilt Ile done in accnnlance with .. <br /> County Ordinances, State Laws, and Rules and Regulations of we, Joaquin Local Health.Dlstrtp,.11lotna,atsnw.K liit�rn• <br /> sed agents signature certifies the following: ,. ._ <br /> "1 eerti#y that in the performance?of the work for which This.Permit is is"ed, 1 shall not <br /> WANNINGIr <br /> as to become sublet( to Workman's Compensation laws of Cttlifantid." "4"Y p. POMM In � <br /> Signed <br /> --- - • -.-.. Owner <br /> } - -------------------- <br /> (I of r hon owned Ti#le -_-.• <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY _....- -- <br /> BUILDING PERMIT ISSUED ---------- ............ <br /> ----------------------------------------- DATE ,....� _ <br /> ADDITIONAL COMMENTS <br /> ------ •--••----•..........:.... DATE ...:..-.-:-••-...:._....:...._.......__. ._ <br /> ---------------- ----------•----- ........... <br /> ............ ....... <br /> _ ..........• <br /> Final Inspection by: <br /> Date .... %_�- -7 .........__ <br /> Ell 13 2h 1--613 Herr„ 5)q ... ... <br /> SAN JOA lJl <br /> Q N LOCAL HEALTH DISTRICT 8/7h 3M <br />