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<br /> #moAPPLICATION,:FOR SANITATION PERMIT ^"x Perm4�No#X;1f1
<br /> (Complets:.in Duplicate)
<br /> d.•.A 'This Permit Ex'irris 1 Year From Date Issued'' Date hsued : /„`”
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<br /> `Th�Paca licefiors es me made fo'the. .5an::loaquin,Local I�ealtEs Disfkif for:a.permi#to'const�uc+and in% i, ,�work h'ere,iY daseri
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<br /> irenee w,+h County Urd,nanCe No1::549
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<br /> 7 � yfEAsfa!lafron wfll i rve Residence partmentFHeusa �� Commeretali© Trailer Court r0' Motafa[j�OtlieF Q
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<br /> r,• � wNumb oflLving unlfs '� Number of bedrooms Number QT.'ba+hs '
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<br /> r , Wefar�d uppl Pubhcksysfem ❑ r Cornmunlfy system ❑', Private ®' �e f{�ffo Water Table ' -e JT
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<br /> >� 0.afk } rGr ,,Y4 'F ., 4JY 1, -,. ✓ft r t s P
<br /> Character of soil,td it de tis of 3`V.et Sand Gravel ' Send Loam C!a Loam: Cle "
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<br /> � Previous?App'llcetion Made (If yes date., t F. ) NoNew,Consfruc#,on: Yes+❑ No°Q
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<br /> t TYPE�OF�INSTALLATIONdAND,'SPECIFICATIONS
<br /> t� JNA', Z(No septic lfank or cesspool permiffed If public sewer Is avai(eble wftfsln 200 feet J ' t ,o f
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<br /> SeEt�eTen1< rte s D, tante}from nearest:well , Distance from foundafion . .. Mc�arel t1
<br /> p h�Y i I. x- ir6 NO Of
<br /> co'm artmenfs Y c Sites _ f__ i q-
<br /> P Liquid depth. f Ca as : ...
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<br /> F jd ! Dis+ante frons neares} well D1 fance;from foundafion:::. Drs+ante to naerestf
<br /> Number of lirias Length oi`each ii'ne Width}af 1#�eich
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<br /> 46 +;F t, ��, "Type 'of filter:mote lel. Depth of filer matertol To+al��eng4h3s
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<br /> "S PE/ .:.. Dsjte�to nearosT'`o� -,
<br /> Seepage'Pi+
<br /> ".'k,,x Distance to-nearesf w©h c1r�,,.,Distance fro fo ndafion
<br /> of pits / Ltning matena3 � .:,5sze Diemetar':: yt °( `iDe�3thtli.Jti- i
<br /> rP ^4/r f• iA}Yl'�i/" { ;yll Yi-- ! I.. - -- l r(A:14 31pA�i yri
<br /> �r� r.Ce spool;, a Distance f,oni:nearesf well Distance from foundation L,mng;maferial� „
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<br /> irSize Diameter Depth, a Liquid'Capacity.
<br /> F3Prtvy r ) + y Dts+once trom.nearasf;woll t, Distance from,near est building i err': I§,
<br /> Dl.tance to poorest lo# line ti $*
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<br /> Remodeling and/or repainnig {describe) r �t 'fir"' �,. s
<br /> 0 R /(/J CLIA+ la>Y
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<br /> ' K ./1;hereby certify thef;l have prepared+his applIca+ton I fhatlihe,work`wi!! be-dona m aceardanee with San :loequ n Co n
<br /> ordinIan!c�er.s' Sfafe,laws i and w! s;ejn regulations:of + e San Joaginn'LocaltHaalfh Dlsfrfct
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<br /> a n:(Plot plen;I$ Owing size of lof location of system in relafion f wells,'bufld+ngs, etc can,be_,placed on reverse slda�.FOR DE ARTMENT USE ONLY '
<br /> APPLICATION ACCEPTED BY �..... !! ATF
<br /> LL DATE
<br /> i y � ,,'BUfLDII G PEiiWT ISSUED .._. ,t r .1:.; DAT
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