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APPL.i C,',T!ON FOR SANITATION PERMIT <br /> (Complete in DupUe&+*) <br /> oat*-ist. d .. . ,. <br /> iOaf. ca^1=�� e he-eby mato to the Son Joaquin L„aa •-leal'h D's+:cf fore ,,e rr co .� � sPd' 1 4- #sns+ao wdrL" <br /> j Tq 0 a rl"csi ron made 'n compi•ance w,+} ^oun+v a re-ca No 549.: + <br /> 1 <br /> JOB "' Nap AND LOCATION :Z�-- �''}. e, i c•�..+f•.n'ef A4 , <br /> ma .Tr'�i'.�J--' - phor <br /> e X <br /> ;r Ins af4f n will serve: Resia �° Apa Iren> H.u,e ❑.:Commercial `�] r=�'lesr Cv. ,Motel;, <br /> ";umber of 'ving <br /> un _.� Number of bed ooms �Number of ba'hs .�,/..Lot o <br /> y1V p <br /> z Water Supply."Public'Isystom 0 Community,system C-1 ;7rivaM ;2q. Dop'k +, Water <br /> Olsuacfw of sol +a a dapth'of 3 feett" Sand❑ Gavel L; Sandy Loam [- Cay. <br /> Prove Application Meds: Yes ❑ tic New Consfruc+ior: Yes,[ J No E! z <br /> TYPE OF INSTALLATION AND SPECIFICATIONS <br /> gg (No w fie taeV ow cesspool p►rmiHed if public sower k oveileble within 200 feat.) <br /> iSeotic Tan:_^ p/ Distance from nearest wall _:. .D¢+ante from ..• <br /> 6-rlLe^'� No. ci compartments. ..sae- ....... :c ao, .......wL".GPaGfy Id".aa,.•._ �fy s.,�,. , ;� <br /> D'soosai Feld. Ulitance from nearest we.._,. .Disterce 1'rom fcu ac' �'a+cin <br /> 1 1 : Number of nos:. .Length of each line .. Widflite <br /> < Type of flte- materia! .::. Depth of filter metanal Tof7� <br /> Seo. <br /> _,pool: blstarca f cm Pneerolwc;,. Distance ncn from u o n <br /> p t , Me?o Dist <br /> !SJ! � nber of pih .. materiel mme'or "t J� r <br /> iii444 <br /> ` s r ! ante from fo ndetLn _.. Lmm snetfene .. n <br /> J S::e: Die mete r._ .:...:_ ..Dep+h :__._. . ..,. ,u:�d Ca+aaci+} ;i 's fM �gelia <br /> Pnv�r• 01s-once from.near st weI r:., '. D a a from n ares+ bu id ng 't •4..1 ' <br /> .. Distance to nerves+ lot liner.'.. ... .':..., ... .::....... .... <br /> ,+/or a a rg (des .r;oe) <br /> I heivbv cort,fy that I bev* prepared this application and +hat the work will be cion# in e<cardonce wiNs See <br /> crdinonan, State laws, and ruln;and regulations of the San Joaquin:Local Hea. h Disfricf. <br /> {� <br /> (Signedll. I '.y'.LC -e'`�f' .72 (Gruen �ndJor Confreeta) s;_ <br /> !plot Alen, ing siftof lot, looaflon of system in relation to wells, buildings, eic,; can bo #lewd an re�Orse s'rdoj <br /> FOR DEPARTMENT USE ONLY _ <br /> lCCEP�FD BY .:_. DATE 2 <br /> - <br /> REVIEWED B _. ... DAErye <br /> BUILDING PERMIT ISSUED ... ._ <br /> DATE-'-, {.t �� +' <br /> I <br /> r <br /> Al+ern+Ions and/or recommendafi m: �/ ..._ /t u�J .$ <br /> r <br /> o.4C <br /> Wy/,.LAJ <br /> �v.,ca ''^�.t.r .� ...... I ..... n _ f. <br /> /• 7 7 n + <br /> Dafe.....:.f f r t <br /> FINAL INSPECTION <br /> BY: ....._ /T'l G:a -- _. •.... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 70 Se�1F Am.rkan Sf.•.f <br /> 300 Waf O.k Stn.f 112 srcatw a sfr t e14 NMF "C"Shwf <br /> ^z <br /> _SancNen, C.I!omla Led., CdftornB M.nNea,Califereb Traay;.Cali/ereA <br />