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<br /> FOR O0FICE .!SE
<br /> APPLICATION FOR SANITATION PERMIT
<br /> ptnn,;' No
<br /> (Compl.to in Duplicate)
<br /> p—r --- Thin permit E%plias Y Year Frem Data issued 4ebluued
<br /> s Merebv uredo to�+he Son Joaquin Local Health Disfricf for axrrnit to co u' cct z rd Ir
<br /> n stall the wank hi'
<br /> 'k ' x rrpl .. „r ix meoe compllace.with County Ord mance No. 549.
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<br /> �a DDRoSS AND�}Oc/�TION AI ' `
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<br /> ~ +iwnar's:heme..... W/,!
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<br /> "t ., r Corhactors Name�/l'�C�1.�j{/-f-r P «•�,
<br /> x In:fe'Ietidn will sena: Residence-I Ape�fm,on+ Hruse ❑ Commercial ❑ Trailer Cr-cart ❑. Motels r
<br /> ^Number of sing umfr.
<br /> Z. Numbor of bedrooms . Number of bags J L s ze
<br /> Wsfar Supply, Public system ❑ � Comrrurl+y systom ❑., Priva fe'�Depth to Water able :::
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<br /> Care-for ct soil to a depth of 3 feet: Sand ❑ Grevel ❑ Sandy Loom❑ Cldy Loo ❑ Ciay❑ Adobe e
<br /> Prernus.F.polication Made: lilt yes,dote - . I No Now Corsfr.-+ibn: `
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<br /> e tired—;+IRNA Yas
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<br /> TYPE OF.INSTALLATION AND SPECIFICATIONS:
<br /> fNo,sepfic tank or<ospcol permltNd.;If
<br /> 8yp rd r V rtmertspubi .... z�.��C,iQ1 b,7leL.within ?oQO feef.)
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<br /> o . �a^k , e ,oerwe% D `` MwgJ4t�t -
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<br /> P'S e G our rea-est we'.i.. ..Distenco {rumfour !o• ,r".,._ _Disfa tet 1
<br /> ,W ceo ',+ ars i+J
<br /> e`- lenyih or each ) e ._ Wath cf trncr:, �.
<br /> e me+e r _ ,Depth of f Ito,.mater ii _ Total length......,. '
<br /> yx� ! ��{ it Seepd9a P Dista o r,.e e t wo I :_ Dlstanco f o, fOUodot a' ," Distance to reerest lot na r i
<br /> 'v"alt�Vwy:' ❑ ^Nur.or o-' „: s. ... -_.L "'q r,Iafer;al . .... Sze. Deme+
<br /> t�a r",iZCesspoo' Distance fiom�rearest wall ..._Diaanco rrem foundar .n _ l'n'rvg mater el.:: I
<br /> S �°.?1,.kk yrr L I Sze Diameter.. .. . ...._ Dopth... ......... quic. Capacity.. gab,
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<br /> -an'est Distogea fom'nearest f:c 3,
<br /> n ReTxo aro';or ro ai ina doscres+ lot Ins.. _... _:.. ..._. .._ :
<br /> Distance to nee,
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<br /> �u 1yt T ;y
<br /> I'll, hereby_cerfrfy;that ve-piopared }hu,appLc Von and t at?he work will be done n accordance with Sen �uinsCounfy
<br /> crdinantes"Ste+a Iaws;,end.Kslas and regulations of the.San Joaquin Local Health Disfricf. :
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<br /> �9�.1 r�".� t5lgnt.rlj 6EPFIC.TArvIC EF VIC'e. .:
<br /> F'3 ^ f.rs 915r sl nrr"A illi Opal ' :. Title {Owner and( i
<br /> or Conheciari
<br /> .•fl M, ooh s ..ay.:. ze a ................ .af .. .............. ..., n ) ... ._
<br /> 3 4�(Plot plan, d owing size lot, location of system in relation to wells, buildings etc., can be pieced or revo^N aids)
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<br /> FOR DEPARTMENT USE ONLY
<br /> xa4APP�CAITON ACCEPTED/ DATE...
<br /> ;SyY " REVIEWED BY.. f DATE... ' am r
<br /> ss
<br /> a, BUILDING PERMIT ISSUFDv' .. :.. DATE .. r
<br /> Altare+iom and/or recommendations:.. : ... .. -
<br /> .._..... .. . _........... "✓ ...
<br /> _ ......................'>� a7` i+dN.A"Ye`nk4': car }
<br /> ____ ........... ...:..... ..........,....... ...... ....... ......:... . .... .:r..:. ..... '..
<br /> .__ . . ..... .... .:. .. .....
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<br /> _ :. PECTi,F 1 �71��""!�" Dais...:. �'
<br /> FN4_. ti's �Y. Rv_.// L ... ..........
<br /> r //9 ,IOAQUIN LOCAL HEALTH DISTRICT
<br /> 1401 f.WUUw Avr. 300 MI.,,Oak Svur 124 SYmrneu St., 205 Woo 91h sir«r
<br /> Sredero,Glllernie leul,Cal�fernla Manpm,Callfernla imn,Califemla
<br /> ca co.
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