|
l
<br /> �,. I`i.i -. ., 'f^.�'�.3t',�'�+a AG_Ya.'.e:n�-. .- _ �: - .w' ,• , _'il `r' - .+ x,.
<br /> �L. FOR OFFICE USE,
<br /> Ai'PLICATION FOR SANITATION PERMIT f
<br /> (Cornpleto bi Triplicate) Permit No.
<br /> .,f.r This Fermlt Fxpins 1 Year Day lssw& 4�.
<br /> .......... ............ From Date Issued �
<br /> e e• �
<br /> fx; Application Is hereby made to the San.Joaquin local Health District for a permit to construct and Insfall l�ro work l�ic3l� `,
<br /> 4; j r . deurlbed.This application is mode in complianca with County Ordinance No. 544 and existirrl Rules_and:Rogulat .
<br /> :10B.ADDRESSAOCATIGN ......... ..oC��l�...-S.r�r�/r��L.. . ................CENSUS'TRACT'
<br /> .r Owner i Name.Y,. �X -- .................................................
<br /> yw
<br /> Add is ., . � ....City . /'4�.. rf,a.. .�:.. . ti ....., s .
<br /> A `a
<br /> //..
<br /> I t ConrraN 's Nemo.......... i..�G, �/ 6. ........................license
<br /> Inst }afI n Will server Residen_e Apartmen ouzo Commercial railer Court
<br /> Motel[]Other .' t........... .......................
<br /> 1 : Nu r f h.ilnq}unitsi....�,,.,.. Number of bedrooms ..Garbage Grinder lot Sirs :
<br /> +1R a Sri p}yr,Public System and name ......................... ...:..,
<br /> °. t
<br /> Clio cfe of soil to a depth of 3 feets Sand C] Silt p Clay p ' Peat[] Sandy Loam p Clay toe `Q . ,+ ' ` `
<br /> 3 Hardpan�] Adobe Fill Mcterla 1 yes,type .,., flim
<br /> � 4.,, jfs�3 "- "v�w,r� .r.i..r _ `��M y ti. 'r�iuX�..�, r fig•,
<br /> '
<br /> IPiof la ,FsFawirt stxa of lot, location of systsm In relation to wells, b #�! tG must bs placm� ort oVo 061 .1'
<br /> it _A:f.-i u a.
<br /> N.N. ylt� LL:nTIOl+ft fNo septic tanlor seepage pit permitted IF publics bre wlrhln 40Citeef,] �*
<br /> J PR[ IREA+'ME ( ] SEPTIC TALC{.j Sixe:................ ,. Liquid Gpt'h
<br /> Copaci fYs-,, Type . Material...... . t No. Comportmen(h
<br /> TYeli . .... ...........FaV�atl Skxii. No
<br /> LEA IN L1N ��( ]' No. of Lines -. ength of.each lir>% �. Notal Letagf'" ` f .tl.st�Y. .'
<br /> Ititer teria} ...Depth 'Fit
<br /> y` ti n
<br /> �arastl! Foundation ' "z Proporfy'LE7fv
<br /> , ?SEE GE IT Fr Depth c Dlamete Number Rock Fipmd^ V a[Q '
<br /> dG x; w*� W t)epth ..... Rook
<br /> L}Ii enc ,nearest ;Well .. .Founds er ~Prop.Linc ti •ae i. `+.:r Ff. GL'
<br /> tt REP' IR DiTI ev Itat� n Permir t ........ .. Dat* r
<br /> tic nkti itirerrients}
<br /> j
<br /> W pa
<br /> F1e ( rementx},...,��r', ..rQ.�..+1.r Ar��
<br /> t L
<br /> .......- -,.. ...."_.:....•..•.... 5 *` A J'd fa4£- ✓J "h �` ?
<br /> .. I•r• _".:.r �,. T+ .1
<br /> (DroW existing and required addition on reverse
<br /> 1
<br /> bY,. _ hG,^th I v neared ihl� application and that the work will be FII eetordanca'wl�
<br /> at7ka;'and Rutin and toguICHens of the San Joaquin eallh Dl:hlet HmbeN: SC G -
<br /> 1 'sedr en /I`s .hr` �011owlnQ:"`.s.• ', -'� - 'a ,r L. 'Y ;- �: . .*'k.', '+�' ` r
<br /> z�l y r"1 '+1 In
<br /> at
<br /> `the worlcfir which this permit is lssued,II s M-employ osry prors >far `
<br /> µ a. wb r 's 'onsaHae laws of Gerlil'ernia" + :ate +
<br /> CtVNner. .:
<br /> ` t 1 a .
<br /> 'v Ilf'artier than
<br /> .r, FOR oErARTMiINT USQ ONLY
<br /> �-,
<br /> APP iI 1CCEPTED BYE., rs I'S°0;� DATE;� "`�' t t
<br /> } BUI INt3 IT_
<br /> T•ISSUED f DATE
<br /> AD TION VICOMMENTS*
<br /> ij r •+.•&.a �sy 1.r.o V,.a i i wrrs � �`%f '1,
<br /> j �, / s a •w wa,.wr. .........' RIM a•�'�
<br /> `� v f9 ti �� .,e, . 1�•N C 4 s
<br /> ? 'a. J 1 ..:r J,!{'aµ if _ 'y "yN1..,. q► •
<br /> yFina ... ........ .. .ar
<br /> JOAQUII�' LOCM„HEALTH DiSTRICT d�` '��! >
<br /> ? ' ,- «� ta, ...7�..-.. - „ 'Y't#'� :.
<br /> r F H.
<br /> +�•.aq,�
<br /> t , x; r �,, � r ,� 'OM1* y��� •'4 '� -'w"4+F - --��—��T�A •'
<br />
|