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<br /> APPLIO.A;VON FOR SANITATION PERMIT iNo. � � }
<br /> tis tr7k 0FbIr-EFt 5E
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<br /> I• T Permit
<br /> ,, is Perini^ E rps S Year From Date Issued Date !:fund.
<br /> q, (Coal li a in Duplicate)
<br /> tom_ a �
<br /> p Roclkfl'1!h'�Y`it f�rnSy'rlada to'the r Joaquin Local H/SMfi DUfnct fl,, u'permit to construct and install thn work hn'ein Jcscribed
<br /> T�iS ap'p:l6;firn mride iry . pli!,Pta wirh Cwnt/ Ordinance No 549 �{�S`s,,,;.7."�' '/F'-..✓' //li it/dQT' ,
<br /> } Y a4ND USCATION_B>/�' o4 o_.. � PF. 'r..-Cs[a> Y. /x-�
<br /> ` bnvnoi fllgtrlY!"rt'`�7J�,crC. .!........ C*r..a_ t L.. ... fhnne '�,�i.AI;�rB
<br /> cn niraCfor'¢ ...tn. ry. ?Fora/1�r!4�9f�T?� Y,
<br /> I'nt+ailafioe ai(I.terve: Residence ) Apartment House [ICommercial C] Trailer Court [IMotel Othe ❑ - 'n
<br /> Number.of living units: --I.. Number of bcdrooms.�.. Number of bathsE.....L Lot Hz r
<br /> mate; Supply: Public system 0 Community system ❑ Private [i]�Depth to`,`Neter Te'nls:.�ft r
<br /> CF.erncter of.oii 4o a cepth of} iaef: Send ❑ Gravel❑ Sandy Loam❑ Clny Loaml[x�Cley 2'�ASIaS; II HerdC3n
<br /> :✓ s -.Ye. No a' --HN/VA'Yai C
<br /> P y IJew Canstruofrorc
<br /> rYv,cu+ Application FYtada. (if es,dote. .....I No [a'�
<br /> T'PLUFINSTALthTIQY ! " SPECIFIC
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<br /> septi, iena or casspoci permitted if public sewer is available within 2004ee+)
<br /> e ,,+ nce from nearest well... Uist�,ca From foundatlorA i tvlater,el l...
<br /> Sop ie Tnnk: e
<br /> L1 No. of comoortmonts.............. Size......._......... L�q'Ls +p)h ... G Peaty
<br /> U �+Psal held. Distanta*om nearest well D' +ante from founoaf on .) Distance to neirest lot ine
<br /> INuM4`ior of lines ,Length of each line ; y"idih of trent}::
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<br /> Type ofiltoF-mafonPl .... Depth of filter matenel ' #..Totphfungih .:. .
<br /> D�s•nnce to ,lea ess.Nell lLlrV Distance from. foundafian....Y ..Dis nn ye to.learest lot",.I'ne'71�.�
<br /> Size-
<br /> Nl,rb�r of
<br /> ( tn� Sz� Dmrorersnear�-well Lining mDeetahce ffrlounde+onDiometr� Linwd� aPf i. �� _ yrnll lr Fr ,
<br /> a
<br /> H, p , 9 .,Cape(:;' w ,
<br /> .Distance from nearest,well..... _ .._.....Distance from neareifbwd�ng
<br /> C✓ Drctonce'to neer s+ lei line.. ---- -............ "
<br /> `J
<br /> Remedo'.Ing and/cr :epainr`q (daicnbel.......:(J' i «.-<.�--'r""T'�'r In.
<br /> s............................... ., _ ..
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<br /> I hsrobyy cerfif +Fat ( have prepared this application and Cher thn work will be dors In otdence tlHl1 San Joegoin County �+.
<br /> ordinances, Stet. laws, and rules and ro u atlrms of +he San Joaquin Local Health Dis}District. '
<br /> �_. ,,oe y •y�yc_ (Ow or end/cr t:orikac+oil
<br /> (rtla(. �`yA�-fcJ- e
<br /> By: ..
<br /> r r (Plo+ plan, showing size or lot, Ucal�on n�r.jifen.m relah:cs b yells, build" etc., can b4 placad on reverse side). —_
<br /> — FOR DEPARVIMENT USE ONLY i 1V
<br /> --
<br /> ' -
<br /> .. 7 ..�� 46dATE
<br /> LPpL1CArl0v eCCEPTCO BY 4 . DATE
<br /> V I EVIEfBY _
<br /> DATE i Ful DING PERMIT ISIJED I ' — ..
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<br /> -
<br /> ' Alterel;ons end/or rec�2 »endariondr� L,' -
<br /> I . . ' �5 t+a•f .J / GCr)I4r2,�.. '�•(�' . . G /" -
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<br /> }..... } (..: T
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<br /> FINAL INStEcrloN Jv._.
<br /> I,
<br /> SAN JOAQUIN I.00AL ViJALTH DI>{RICT - s
<br /> I eve. u
<br /> 000 War#Ock t•• # 124 SYm,nen Slraa# 265 Vi 91h slraa#
<br /> :# a01 i.Na
<br /> I ? slehlon,Ge"14liNenN Sad6 Ca'Ilarnla Manbea,Celi#ernla Ta•y,ealllernta
<br /> .( y nc,u[O .'Sa ]M'1 ill r.e CC.
<br /> •. ... - - - i.xw x*NryW,m.�m t r .rw .., ..r u., v.'..n 4..r � • i.. �,�F\�Ay' -. �w� ��(
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