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<br /> r � x FOA OFFICE USE,
<br /> APPLICATION FOR SANITATION pERMIT
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<br /> !complete fill e '
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<br /> 71110 Permit fxplres'r'1 Y�pr,P�ellt:t�0�.. n �� �z f xs ' r x a•
<br /> !r,•..'h ,7,r 7 .'=^t•, ` �� 1- €y�
<br /> ` � >Application?is hereb .made'to the Son Joaquin tocci-.tlaalth`Dlstridrfor, rTr11t;ta.'�eonstruet arte�xfne illtllto,tNo hrrein„ `F
<br /> ;k t described Thfi app!cation.is made in compliance,, with CoU} and* !�!i w Rilfef pn� IaftOn 5+ r "
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<br /> 6f�tr.� c J1.?B 'Ai�DRfSS/LOCATION
<br /> bLf��ih7 .fel." A 5a c+ 3
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<br /> B1:n cJs Nt - 9 -.•r d_; _, 3� /,'!7
<br /> Owner`s Nar11a 4 ���'r1 ULt.:I c ... .:. r .......... W
<br /> ' AddrOss p.;0 i I�O/+ 4 3',./ QI►.M/,[7�. /.5,� < J City,r �lyp#t `z
<br /> ,ka.� rash sOH� LiCN1/e A ye�Y.r3 i PlfOttl 'y�l� l.�sn�r,�p
<br /> Cantr6ctor s-Name
<br /> .�7 �N�:�}..��`?�'0'�=�fos +.N *r'W? a '�h4�t3;�,r r'^ i "'r.a,i^.f .uwF ,,N t !.: ':.:xt + �;;�a yr'„x'•�,'� ^t.jh, -
<br /> ' `yYt+ of
<br /> k'e N rnFffrsg�F J1.1 In:szt'aml'l_a- tiX'onn w_:i'lt,lx'•srey rvI,r e,s�THals6�tr y f 4.,o'1 fr Rosci. once'0 A.m partm;.pe'nt Houser flqCo,mr}nlerclali z ra,,,ialt;aet9,CsouyYrt �, e�3t
<br /> Motel,j7 Villar &U,
<br /> Simi,
<br /> Asia da S 1yf';vat i lY ?fY x i
<br /> r 4 s l+�urnb& of�living units Number of bedrooms ` Garbage Grinder i r tat Slxa r..................kt r ,
<br /> k .................r, , .. L 4rivoie
<br /> x.hl� �t w•yv ZB t?!F. 4 rt•: i -.: ;� 1 -• " '�y • '•-
<br /> k cn Wotsr Supp;y:^Pit bIIC System and nen e " w F
<br /> � 9
<br /> Characterof¢coil to a depth of 3 feat: ,Sand p f Silt❑ .�CIa�Y+} Peet❑ Sans! Eoorr © ' dvleant©.. r
<br /> Hardpan© Adabe'jJ> rill Matirial �f,yes,n!Pe '
<br /> ''x' ' 5� r' tua Fiat f. a ss a^ �.
<br /> a i�+F ;Kz-
<br /> b etc must ro• plexed'on re,Nl'iti'L�i :
<br /> (PIoT otpn;showing size of lot, location of=rystem ir1 nla#ion tto'wells, uildlR s,
<br /> Q � Y
<br /> iFtnv tl taRlC Or seepage, t i avail4bie w�thla�204 feM,)�'a!` s
<br /> �� L NE1N,I[+iSTACCA ISN:jr jNa sop apit per,ni4f�if blit Bawer s
<br /> 'Capacity Type Material No Cepa Y x
<br /> LO RaareStt Weil C : +
<br /> Tota Litip't
<br /> ry } LEACHING LINE ( ] Na of Lines` Length':of each line x `•'
<br /> �._.
<br /> D Box Type Fitter Material D.tpth F1 t0Materlol�
<br /> .'
<br /> ";fir' a�' &'Q �w G ' Distance to A.
<br /> nearest: Well Foundat�an Prapefyl
<br /> R r rr car r 4
<br /> SffPAGE PI7 Depth. Diameter ,Number Rakfill �YQ;,
<br /> c Water Table Depth Rock Size
<br /> k 4
<br /> Prop.-lirw
<br /> r a� � a t �"�Dl:tance to
<br /> nearest: Wail undatiankry ° +� ...
<br /> : Fo
<br /> r y
<br /> �w REPAIR/ADDITION IPreV Sanitation Permit sp '"Sate 5
<br /> a t t 5eptK Tank"{Speedy Requirements]"
<br /> ' n 0(sposat1l is d IS cify Require+nantsj ,(>ri� t ,�/� 3r 'yzS{
<br /> wr: - ` %. + y =r yrs+M„ {
<br /> k13t. �1'Zptf"'f T]�--n + 'Y ).�1 F ? Y' f
<br /> r t} ••-• '.' .yfisv,.a `.fy ar
<br /> {draw existing and required ad
<br /> Idition on reverse side) �F ` kap
<br /> rrt ttlsA
<br /> < i hereby certify that 1 here;prepared,thls',appile6Flen and.'tha! the`warlC" will bo ilone.ln aeisrdenla�vrltl!San �Jeg4 -i
<br /> >t:y ° Colint�r„Ordinanies `Stoto;Laws, ondERules and RliO 011bn:::of t►te San Joailuin Local HemUh basMctFHenili;erwn�r er Ilei n
<br /> sed gar ont'i s1g`^nature certifies:th6 fellowlns: w,ya
<br /> s � �< s �,Lc�rtifjr'thain hi p*eformanei of the,work for which 161 3giswed, 1 shall:not employ any penaaein sl+dna
<br /> rrtnneti'r� '
<br /> as to become ubj. io WrCman' Compensation laws of Callfernla
<br /> its a l.f�,yQtt . Owner
<br /> yr
<br /> d Signed w K t r
<br /> Title
<br /> {If at than owner] `� wtitb7
<br /> v XR rd F v v,A
<br /> FOR.DEPARTMENT USE ONLY
<br /> a •';
<br /> �} AP PLICAT16N''ACCEPTEb BY . r _�. 1 r cz..rr� %a r7 7 i
<br /> _ DA1TE l�r�
<br /> BUILDING"PE 1
<br /> ADDITIONALRMIT- 155U1iD � DATE,
<br /> Ma f }r1M li •1+ + �y, if a4!y S x {:
<br /> * et COMMENTS
<br /> r'� � `5 4 r '�� � � `�",,��x:, +� . G$/,�=w^'• �C -� '""w/Ufitff,_ tr � � �� .,��,.
<br /> Finat In.pecfion by ..........................
<br /> �! ate s '�,�- � ,r t 4K +5���riry►•t"F
<br /> 1 ! 13 24.: ;1-6fj ;;;ILcV. 5Af 5AN JOAQUIN:LOCAL. HEALTHDISTRIPT a 87113H
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