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<br /> FOR OFFICE USE! .
<br /> APPUCAION POR SANITATION PERMIT �
<br /> +• hermit No. G
<br /> Mompleh In TdpllftW ._ '
<br /> ......................................... ' Daft
<br /> This permit Expires 1 Yew Frew!Dale lssvrd
<br /> ...
<br /> ............. ............ .
<br /> . .................
<br /> Application is herebymade io lite Son Joaquin local Health District for a gm It to Construct and instal) Titre workhen�•^"
<br /> 4 described.This appicati" is made In oomplidna with County Ord'" "No. $49 and existing Ru1K and Rpulotlo�
<br /> JOB ADDRESSAOCATION -_-- -othrimr.;T.11y..de_-Earn®y--.Lang
<br /> Owrtpr's Name .ry.J1a ..:GgB............._............................... ................./.y................... y• :>
<br /> Address .....32ii~']...E-.-Yal `. ...........................
<br /> .............................� L.Y..747
<br /> Canf odor's Name.Hlack��t,b..................................................._..._.._..license. ,Z�y$45 ....... Plrone .... 'r
<br /> Installation will'serve: It"Idenh]e jqApartment House C)Commercial)C)Tradier Court .fl r
<br /> 5
<br /> MaW❑Other...... ....w..•
<br /> . .t4l icer of livinu „h,lts:.... Number of bedrooms ....I—Garbage Grinder ........ Lot Size
<br /> •�.4Q �4 a � d
<br /> -",2 �,
<br /> x m"
<br /> WQltir Supply: Pub11c;iyst"m and Warne �:. . ..::..........Private
<br /> a
<br /> of tail to a depth,of 3 feeh'} Sand Q 5litb � ciay p •Peat[] Sandy Loam(] Gay loam D
<br /> Hardpan£ Adobe Q Fill Material ............If yes.type............................ ' k
<br /> �r 3p bk—showing site of lot, location of system in relation to wells, buildings; etc. must be placed on rs+verss��.)�' `=u
<br /> .4
<br /> %jWA1LAUM: (No septic lank or seepage pit permitted if public sewer is available within 200 feed
<br /> •'�'��.!��!' �J�.r-yA•�-�l�3�'ry.-'Yi'.t 1-,. 48
<br /> .... Lquid DipthTATMENT pq SEPTIC TANK( Size _.
<br /> 4a 'I -`i �. ._.._. Type .-ps.....
<br /> (o *orewe", PM UrAi1Di�
<br /> x
<br /> UNE ) No. of Un"(.-.-_..2............. Length of each line�t;p!. 5 s Tatdt 200!
<br /> 'V7''10*k 'D' Lox Type Roar Material
<br /> Distance to Nearest: Wall ... . Q...�-.._ fouridatio)h`... j...';Prajie Line
<br /> r Ds 2 !. 0larneter ".... Number I _....:.., :._ Rock Pilled Yes
<br /> Water Table`Depth ..90...................... ` Rock
<br /> Distance to Morest,Well _-••-./z2a.....
<br /> ' ..�
<br /> Appi11QN all
<br /> {Prov. Sanitation petmlt*.. .........µ..........,..:.. ...Y.. Dote'-- _ ��` •f t ,
<br /> lc. IsliecifY "ulreh+ } �.,
<br /> .,�T `Ai tl [spec* Raquitehinmhh}�......2t}l 'Ze�oh..I,.tne..dt 2w.....�,�1X3}"... #.8• y a ``.. s .:»,.. ;'
<br /> ,,,a,,. ...........:.............
<br /> ... ................... .... ••, Y a r
<br /> ? 1Draw exi�_a�l required addition on reverse side)
<br /> a 4lo #en and'that the work will,be den* ln"atterdsmn
<br /> l ; ea1tllyr,that'i hew Prepared,this app
<br /> �. &dW0kW;State Laws, and hale and-kogW dens of tM Sart Hogvin Wool`keolth okmo.Nowke-owner do *--Y
<br /> • :'etrifles thi falle�►Irhgh re
<br /> pwfermame of the w"for vA*h this.pernrlt is issued.I shall thea.ehhptey"YIN such tthitartar `�
<br /> L{� Qn, ievbl)ed to Werftwhmh'e Cna+ laws /��II
<br /> er
<br /> � s'.• .. .. ................. Title
<br /> h .... 4'
<br /> ' }x.`� Of other tha�il oownerl
<br /> ;'10MI VARTMiNT USI ONLY
<br /> A�J1 LkAnON ACCEPTED 8Y. ....
<br /> ........�....... .................................. DATE~..... `�......'... ...... .' .....
<br /> 'BtrlL�JltrG tINIIT ISSUED. _....N ........11.........•.........................._..... .. ......,.........._: DATE.......:....... ...............:. ....
<br /> eAGMONAL COMMENTS ........................................._ ...............
<br /> ..... :...»,:....... .::. .. ...... .... t
<br /> + ........................... .p t..�. :/�+,......�7 r.: :+�.� % 1 •"»..:... .
<br /> Finalinspection by= ...........................:.................................................>............. ......Care. :�.,,�...., � .....
<br /> ' AN. OAQlJlq,LOCAL HEALTH1 ,
<br /> E.H.4 1•'68 Rev. SM f
<br /> A�'- w;xrrd+�».wi. � ,wv.+..� - .. RE.—`"e:�-+;:S,re�a�sud=ya, �`y�3"x..,i•�: .si` F�����''�i.`.�F�: "'.a"�°siw'>�'�. ..-:ae'„ ta+r.�k:+..� � ,.
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