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fc-�Of td�E USE! <br /> .. ..... ...... ...... ........ <br /> APPLICAnON FOR SANITATION PERMIT Ps,mif No. .../..fr�r,?.f...r.' <br /> .. (Oanrpterls lie D.POnhl .. .... Doti Iou.d ' Il e�.w <br /> �23'$'• r-" Mie pWaaY E.e+n t Y" Ffam Date hard ( <br /> A:V&i,mlian Is Iwrebf made ao the Sm JeNpfin Lxei HeJ1h Dat.rc1 fore p.«n;r to ca.d.uet a.d I.tNll the.04 bMin daaefbed. <br /> Thn eppfiaef'we it feed,m cemp"unc.wiM Ord'. Na.SW. .Z`f$-b70-35 <br /> SP Ito& I>IwY l- eD W 4 CAVRo.74. / <br /> .SOB ADDRESS AND LOTCATION. If D "44/. y !'a� d7'eP .C.�O t% ._ . . rse -0?4. <br /> V.t:7 .E_ . .D.4 S J O N.oem TF 1� .l.y.3- <br /> Add.as]... ........... fA - .f. BdA /.I 6j�au ei I ... I __. <br /> Canlrsdens Nt.e ...040th ft..JP'✓7 C yaps✓ ...Phare. FY.L-✓L6 <br /> M]lJalie..Dl" , : Recld,eea ER—A0R+ .nt V+ .❑ wn.,rc <br /> Cfal ❑ /Trema Quit" d MeM❑ Oflw ❑ <br /> %, baa of I:viAO t4lff:..i...Number d 6adraams-Z Number of be*, If..Lo!life ....9CI].CA.fE..<... .. ' <br /> x <br /> Welw Supply: P.V, ]"him O Comf..nily IviRNm ❑ Priv.%,EIS DWIi fa Wef«T*i .3.St I, <br /> CL«ed«or yi1 ee.dpa6 ai 7 fe.f:,Seed® G.twl[] Sandy Lao.O Clay Loam O Cl"O Adot O H..dp.e O <br /> P..r:w]Appik fie.Mrd.: lif yes.dafe 1 No Qs, He.Conf}ruclmn: Yes jg�No❑ NU/YA'.Yes L„ NoZI <br /> TYPE Of INSTALLATEON AND SPECIFICATIONS: <br /> -(me saphc ttfdf a,couP••I pati.Had it pubk sews,Y a 8"Iss W NN 200 60.E- <br /> SeP5 .M: Onra m 4"' ne..asf We: .... 'D'W. . from laandeTan_._ ._.__. M.NrfN <br /> EJ(O.LaTT IJ�i' No. o?cumptrlm.ela Sin.... ... . . . . . UquId depth.. . <br /> D�fp�eei Fia�d: DWence 1'.neewO f101 3"O f.Nstatu frown fauMation _,Sy_f. .Distance to rwamit_bt IwR,.S..�..... <br /> N.mbl of limos... % .L.ngM ei.ecl+I;ne. S'4. , W;dM of beach..• 1RO ref.W r <br /> Exk Tr NG - <br /> 7^ <br /> APP Type at Glw.r mat«i.t POCJ{' Depfh wT Clfo.maietiol /!', taleF temdM 3:4.'_ •-D <br /> Y vey-pit: D.]IsoC. to n.mwt wdl. <br /> /410' Dufexe(•mow(nand.}ion -6-' ..D'wfenca b Reare]Ybf lu. <br /> s' <br /> Ne.bar of pit, / Lio-rq malarial. eocif Sao: mze <br /> Dieesef .. Dapih. !6 / e✓L-��Y <br /> Sa^spool: Dmttec,,from eemro i it . . . ..Dido.from fa.rd.t;o, .........., Lmbud matte al.. .s' .. .. , <br /> N <br /> ❑ Sia C;amN« Depth ........LiQei6 Copse fy Seta. .- <br /> �� P,ivv: Dalanw ffo,,nus w.Y__. _ .. _ .. I D:sf.ece F, r,tte.f Wilding <br /> t t <br /> Remecfel ng ena(m roNfmq ldcu«bo) _. • <br /> r7�rf/ill.✓j....fa✓d .•,r`rra�✓c _r/taJAJ <br /> 1 b,06T eei igy n <br /> hove pwped eh.eppr4at.ted"HM wad wA be dame,k tlxordenaa.ilh See Jesu <br /> .ser.Cdp <br /> WaMmMI.'mot la"./4,4 min mod!IWWtaww.1 IM S.Jrgrm Lead He_e/Nh wwbitd. <br /> (5 �'�/fPT..�G/C/..cOA!!l•f..Ylcc ;-1�,�C....ys4'fF'9..._. , ,0�teer ard,a.CaM1ta}.j <br /> rP'.v -h9�' � <br /> Me'PV's,•dw.I,y s,3.d l r+t4a oaf ePdam do rtMKe.ti.aWe,befYMWf.Me..un M Pie..d en re.a.r IfdiF <br /> « r, <br /> -- FOR DEPARnmiar I;aat i TDAtl <br /> APPLICATION ACCEPTED BY. DATE _ <br /> REVIEWED BY _ .... _. _ . <br /> BUIU ME06 PERMIT ISSUED. .........._ _ DATE... _ <br /> FINAL INSVECtto. <br /> SAN JOAQLIIfd LOCAL HEALTH DISTRICT <br /> 'set I,NrO.'.a`W leo mow 0.f Y«M sae Hfe«m�Ar.1 ie]w«.eO Nwr <br /> YWIe•.4]iwnN tW.CY:+vn'r W+xee.a.��wnr T,..rCsa•Mn�. <br /> A r IlMlu.to au] e].uCo <br />