|
�r
<br /> u^4 S�+� �,v _,'h„1'_�" YS!'^ u+xR�_'F'.t'. .A rr'N�Y�"`3.�'.+FPr i r'�fs""W.�k�N�/✓aNq�ILKnY•;+':w�r.�J.tha_fI Nh'�i
<br /> .PPLICATION FOR SANITATION t v9CT D M
<br /> (Cemplafa in DupRcafs)
<br /> ✓ - ,.py, beM.'Iit
<br /> _I s saroE lade .o + .
<br /> '^n Sar Joege n Lc<al Heel h D s.riot for a psrm t+0 cor,1-uet a of msT6 -
<br /> ,
<br /> co:nr Ince w;hh Co..n y Ora ae e No..549 > N
<br /> ^'[.'n�).,s'7C.AECL..•L'�-"l'/.}J,/JJ.�, g'
<br /> ,
<br /> lr :rbsF
<br /> j
<br /> r Fs+al:ata n will sena des dente "'2 Apar r HCOLe, � Commerca' i. ) Trailer CDo4 0
<br /> a ts: ..-- Number of bedrooms _,.--Number of be las >+ sde; Aa
<br /> �q
<br /> t.` `i +Ar'ater Supply: F'bi , systar'n..❑ Corr mun:+'y sys+sm [] PriYahf}d Dep-in taWl+" Taola'� Y�,, .
<br /> :naracter of sa'f to a depth of 3 feet: Sand❑ Gravel [] Send-yLearn �; .Clay ^mr
<br /> d r
<br /> 11 P er'ious A p'ication
<br /> Made! Yea �� No Now Consri,c''on: Yes, t.,,z r ih
<br /> 'r aE CF iNSTAI.LAfiON AND SPECIFICA IONS:
<br /> !Nm septic tank a cesspoo! parmif+od If public sewer is available within 200 feet j -
<br /> y� - .
<br /> d_ I ••c ^ ¢9rco em a ," `rve Vistancs horn V Incl on. ..,}++C+ar eI
<br /> ' C( C •cI mans ...'sib ..... Ua .5Cfl
<br /> �) s 1" tt
<br /> r' c sau D Ir e trc,. varest/`�'e�pc�� :Ds+a ca from t /on, 6� ..Ds z ee
<br /> ct Length ofeach a +n of trenC�i
<br /> I)Wh o' file- Ian Is
<br /> .re � n+ar m_`erI
<br /> t. s f :: rme io earms+ v e'.I,. . ....D'sfance from tcun ':on_ D s"a ee to'nd6 ..f ti
<br /> c( P+ ... L rg mn+e el ze D l a D.,
<br /> g r
<br /> e s rrs+a ce f or^ Merrily PelaJ D ^ +a ce from fou I}o _ / Li g me rd
<br /> Y.s y`�4 c re J�IMn, i .Z�y.J O Depfh
<br /> Dis+enca.fro'm nearest well r D stence from ndaresf bwlding
<br /> "D�stence to,inaarest lotllne m°s ,r
<br /> L +' ,
<br /> w
<br /> hmanv certify that I have prepared this appllc ion and.that the work will be de an acco daneawiNss
<br /> c,c nenebs, State laws, and rules and regulation- of the San Joaquin Local Hoelth D.s{•et.
<br /> x. �v
<br /> (Sro^adl -i
<br /> v' - r
<br /> f
<br /> i �a7
<br /> _.___. ..._ ....... ... ... .,c.- ..
<br /> (Plc+ Pler showing zrse or lot, location of system in relation to wells,.buildings, etc. can ba placed onS
<br /> FOR DEPARTMENT USE ONLY _ 5::' ",E,A% W#
<br /> xg vn APPLICATION ACCEPTED BY y ,�,: hY` ..� t ,,,,`---�+
<br /> i;
<br /> REVIEWED BY-..:..... .. �'S�'� Y.•'i1 .. s� r,d ek7 c
<br /> BUILDING PERMIT ISSUED....:;:
<br /> Alterations and/or.recommendations .. " "..`:.:......... ...........
<br /> �p
<br /> FINAL' INSPECTION BY....
<br /> SAN JOAQUIN LOCAL HEALTH DISTRICT
<br /> LF -)G S.Oh Amencen Sh--f 300 WW Osk 5frut 132 5run+ore Shea^ 94 lfonti
<br /> Si«kfen. GI',fo.nb Lbd7, Cdrtornle Men rea• Cd lmd_s ?e q ra +ornG.
<br /> �t< ~
<br />
|