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FOR//OfF:CE USE: <br /> APPLICATION FOR SANITATION PERMIT Permit No. -L•�I H�'-� <br /> Date iesued ...`.r./�//�---- . <br /> I This permit Exo;m I Yoar From Dale isssred , <br /> Applical-im is hweby made to the Un Joaou n Local Heal!h Dk!rict for a oerrm;t to consttuct and imoa(I the+rork harem descried. <br /> 1rs a Wfio is made in coTpliance with Caurty Ordire^ce No. 549. <br /> J ADDRESS AND LOCATInra �/f�. ��. „� . f ��• � ..........._.. .a..__ ...... ......_..._ . <br /> i r <br /> ... --------........... ...... <br /> - <br /> Address..«.«_.�._---_.��_t.:.....� --'C•�.....=r._c.:.- ..._.._....._.._.�:..c,�...,t�--�•�------�•-•-------.___.«... A ;_�_-"t <br /> 1.- . <br /> . Cnr,lrector's (Jame.- -------------•...... <br /> ImtaAstlrJtl MIII Sart!: f:esidgnce ❑''+party-ant Ho�sP ❑ Corwro-cie: ❑ Trailer Court ❑ Mote! © Other ❑ y <br /> Ili <br /> 3 . <br /> Number of living un;f%.- f Numb Number of be ./--_. Lot size ...._... C..._:......__lr.�..___ ..__» <br /> ;t <br /> Wafer Supply: Public system ❑ Ca-mm m, y syste-r ❑ Private_ Q"�Depah to Water Table 1"_ <br /> Send [] Adobe Hardpan " ' <br /> Clsarec+ar of Sol+o s dap+h of 3 fad.. ..•nri © Gravel[} Sandy�oam�,a Clay Loan Q-"Clay❑ <br /> " Preous App�ca+*-on Made. Ilf yes.date : No 0- New Ca.+straction- Yes ❑ No [} ' FHA/VA:Yes Q NO[� <br /> ci <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> P�permitted if pubic serer is avaaable.i+lsis 400 feet.] _ I; <br /> {NO flip+iG 4an� Of C <br /> 5epfic 164- 4 pittance from neared wc, .. . -...... -D-sta-ce from fou-�da!;or+............. M1.te'e•;al. -...._..._....._......— <br /> ?iL.v <br /> .. <br /> No. of coml?artrr+nls. Capacity_- <br /> �j <br /> ,. <br /> / ,- r �+ tante to nearest lot line r <br /> M.pos,jl Field: D;>tence from +-earest wr c .. p e.arce .re^+ fcundafian.-'c t------..Distance <br /> r-a•� t _ s� a�a�Lf1 �iM1R'. %�.f...! ?i�alC�t�l Of trCnCIS.........: ............... <br /> LJ rrumbor c� l�nm....J......... - - 'g ;V .� <br /> ia1Type o+ filter materiel..-�CL'��.f)aot', of fifer rr+eteriei.../�:...:. •....._?otel length-._.«J��----................. ;„ <br /> err/ Yr' <br /> Seepage Pit: DiOance to n aml wg�I le,e, -D�starcc f fa�u+dat:on-.c_. . ___Distence to nearest lot one---.�-�j.M <br /> ❑,� TJumbcr of pits . . f _ .. );,.r,q s.o'c* ._ �� Sr_e: Dametcr. 1_ .,+�._ . Deptk.. .��'.S <br /> Oetspopl: D;s+Inco fro++ +gra-at! w.+i!..-_..... .-Dirarce (rcm foundal ort _. ...... Lining material---..... <br /> _.«..-..« <br /> 'r <br /> S,za: b e . +R Dra!'+ _,....._.,..._Lkgu.d Caoac ty ..«...«. R <br /> ;F = <br /> r1R r. <br /> from nearest bu:ldinq.......... .. ...-...� ;_' <br /> © Didar+c>, !o noard�.t tet r�.� /y .... __, ..._.-._._......._._...._..."-./..../..............._._........�.y.......�-.-.. �F ; <br /> ftttr++o��r•!irg n++dfOr +*�,n;r:n{I {dfl4ri6e+ <br /> .-.. .... ..........._........_.......�_. ,�.y. ..-......�. ...«..._...'..—.......«..-.-................�... .--.-......«..........«_M. �. <br /> ! certify fl+st!Moe praeaarad+his sppKcsfiee end t6af ft%@"*A v4I>be done ie aeeo"J& wills San,losgssin County <br /> prdinslnos7, iiah (srrsJ clod s++d IggWj*t;orn of +#e Satz Ioegx:n LaW H"Ith Disfricf. <br /> ..jr•�-J/�./�.�/� '! ' j f - -- t..C'.. +nd/ar Canhsctar} <br /> ,174110) <br /> I (PIo1 p4an.ti►e+rin rtee of 6t.i�K~of s�rzfar+s in rewjkm fe wok brolVw.9.ate..can be placed on revere$ided 3 <br /> FOR DEPARTMEW USE ONLY <br /> i. <br /> Af PLK'_AT1OH ACCV T£D CtY DATI:...•_.F} ?/ v.... « __..... <br /> RVn0N.D B DATE_. <br /> _...... .. .. _.._.. ., <br /> _ TE <br /> s <br /> BUILDING, MMlT +55'�W ................ <br /> I1h,erefipfis sr+d/er +pend r/''1 f �' _.tom e•�-r-.0..�-T.� !:��_�-�'� ..��...�.4^�..�' <br /> � . ......r.�.._._...,yam `-+. ...•..:7'`!c..-r �'. 1••. tr{4 . ._. __._.-...-.�.............. ... ..................._......�..............._.._.�...._.. .� I <br /> l ; <br /> ____ ... ._._�...... ... . _ . _. <br /> ............ <br /> r FItdA1 a.S?£CT10'l B'!:. . . <br /> Deft. i'-f_-.�. J ............. . ........_ ..........,...._ <br /> SAN 30AQt11H LOC�►L HEALTH D�fA1CT <br /> 1 sit[.shwa A.._ 300 x...4�3�.r t!a Srr.�•«.s►.... "S W"t arA SsQrf <br /> - ti�� LrN.(}r.I.r... Wwrw.Casluai* Tr�rlr,CslHawfa _ <br /> I <br /> w <br />