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FP K OFFI-E USE <br /> Perwa No. -- <br /> A^PLICATION FOR SANITATION PERMIT <br /> (Complete In Duplicate) Dale Itnsed ......- _ -....- <br /> Thi5—P amif Expires 1 Yur From Date issued <br /> P pplicacon is hereby mode to the Sen Joaquin Local Health District for a perm;# fo cM+truct arm :nAe! .ort lsNeie lleece�eslL <br /> Tni• a//ii��PPI' g�''y%%qq��(('y�ymade <br /> nt o • No. S4V. eq�qq �J <br /> JOB'A�DRE557SN LOG Ti _ Jam-^ <br /> 'QAl 6115 S.t°� Phone. <br /> h Count went �--'•y". <br /> Owner's Name ...._ ..... . Rr/. �/ I�6I i(00M/S W <br /> Address.... ._ � .. . �t,a.a.e�Li...... . . ..... <br /> Phone...Z�C'�:.��».it•� <br /> Ccnfredor's Neme. � � •moo""«��y <br /> MINI ❑ nlhor Q <br /> Installation will sary Res;derc• ❑ Apartment House O Commercial Trailer • I <br /> Nu,ber of Ib;nq unite Number of bedrooms . Number of ba" O'lo tail ... �iR�• <br /> Wafer Supply: Public system ❑ Community system O Pr;.sb)KDet to Wafer Table O/Oit. <br /> Character of soil to a depth of ) feet: Send O Gravel 0 Sandy Loam 0 Clay Loam EJ C1e1 O Adm <br /> Previous Application Made: 111 ye• dote I No � New Construction; Yes LeS rye O FHA/VA. Yes❑ MOO <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted IF public sower H available with" 200 lest.( • ep4/Jy- <br /> $eoKc T 7 dance from neerea .*,I TO' rDMane? from Own etion 4V Material <br /> r./y�f Na. of temper}mark. S;»4..ht _,./'. _Liquddepth y • Capacily..f�� <br /> ufoundation. 010_. .'Dilor ce to memo le IPlsa.�.7_ —. <br /> Disposal d: <br /> Distance from nearest well S,404 rD;dente Iran r '�0 W, e! lranch �� , <br /> Number of Encs � Length of each lme Total '24Y. --" <br /> Type of i;ire• material <br /> sf?V14 .Depth of filter matenal �j • o al length <br /> Scepe9 D;:tante to reroos,well 001 of Distance Ir.n i at•Ien �Q......3 t041V te�tresl'Of f linea a� 6 <br /> Number of pits Leine) material S;»: Diameter <br /> Zo'.Spool: Distance Lam raerC:t well DOW^ from IOYndaf;on Lie;ng material <br /> S.to: Diameter Depth Liqu;d Capacity <br /> Pr;,,1yJ., D'stencn from .•,erect well Dmat ce from nen•esf building •/ <br /> Cl J;atanre to noerlr•.f tot I,ne <br /> RnviOdrhrn n•': •:+r n;...,r) ;r�:Xr'`n1� �� • <br /> _ A <br /> I hereby certify that I have prepared this application and that the were will be done in accordance with Sen Jwgs•'n Ce,wfy <br /> ordinances, S e lows. and rules nd a uldices o% off,the <br /> n_J-oogq;n-Local Health District. <br /> c ' `� (O••er .ndand/orCnnl.ac+a1 <br /> - Q.lt�*4- <br /> ISigned) Title <br /> 4-a-Q—?c� ,e,( l 1 <br /> By eft cs M placad side► <br /> 'P;„t plan, showinq site of lot. leeafien e!system Ie +araban wells, blsitdia9s• —_ <br /> FOR DEPARTMENT USE ONLY <br /> DATE <br /> PI[D B, .✓ ( + .� DATE <br /> / e - DATE <br /> B"4Du+G c-E F'.•r' ;'.SUED <br /> AlterNrons and/or recommendaKem: <br /> 1 ' <br /> SAP; JOAQUIN LOCAL HEALTH DISTRICT <br /> 1 N Sy<enar.Sir••r t0+W.•9•w P<«r <br /> 1601 l Muelren ao. 300 W.0 OaY S"... r•e•r Cell«nil <br /> laN Ce Llernm Menem,Cull••ne <br /> Sudan.Ceilerw.• <br />