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T FGR gFFlCf us APpOCATION FOR SANITATION PEIWO <br />rmh <br />p No <br />A I[ pl ! PIIwM <br />Dam lewd <br />iFl.y.rmuB PI I Year From DN.6eped <br />Is bemw Medio e a s n tool H hM1 Dlr Far o penmlr ro i and Instill M work mi <br />ApplNona q d pla with OnMy OMlonre 5 and exlarrgRl MRagule <br />a.:prlb.d. Th PplRar <br />JOB ADDRESS/LOCA710J. _..�+\Q� '44 `W <br />Quarters Name <br />_enane 3EC6o'7. <br />Address <br />Hooted __ Phorm _......_ <br />Inswllarlm will serve R dena,UApawn HureO Commert all]iwller Coun❑ <br />MOMI Li OIFer -_ <br />units -- Number of bedraems 3 Gmbog° G i ... Let Size � 'P i�------ <br />wter S of I , n9 PowMfl} <br />Water Supply..11, 1 Systemadmem: --- <br />1 cAnrannrnf eolrep depM of RfP» Band❑ SAd Cloy❑ Peel❑ hIf ytMiW"Now CIo ILoam <br />' MardPan pj AdoMQ FIII Mahriol ._.__.l{yaa, ryPe. __. ___.—_..--. <br />(plot plan, showing 11h, of d, aotm of yshm In relation ro wells, bulldings, ncmust pleaN on m ride.l <br />NEW INSIALLATON: INo eeWic nnk ar ewpagepit permuffandf�°blit voilable wilFln 40p (eerl L � <br />PACKAGE TREATMENT 11 SEPTIC iANK�j She V,—/p - F, $- Dead Depth Y <br />Co Pooh TJ-iyp'r ^ Memerml NO <br />- <br />Doi to sP Well SU __ Foundation /m Pi LI . <br />LEACHING LINE j] No. of Lima Lmg F of EaCh Ilro %tf, iaml L rqM %oP. <br />1 D' Ba y iy" Fiber Material s7/7 ._.. Depth Fiber Material <br />D'nars N Well S O F ndotl /o _ Prop" L 'f... . <br />�I�. <br />SEEPAGE PIT L � Depth f Diamond s;- Numb, f - Rad Filed Y,i No ❑ P� <br />Noter Table Depth 4r ....R k5 %f•T �'" le <br />Dkm,rcamwvm,b.W1l1./!iA Foundation/O _. Prop. Line <br />REPMR/ADDIVON(PI" SOnspatiml Pe=lT# ...._._ .. Date <br />Sam, Tank s iY Requ n 1 -- -- ___ <br />Uspnwl Field Specify Requirements) -- <br />1 <br />Deaw, existing and matured <br />1 hereby Try b I he" P P tl rbl pbwn d M the w d <br />wk 11 6 d in aN MIF SUR JOUMIN <br />Couple ad mance:, SeatsLaws, and Roles andtag IWI s al M° San Joel Health Dis d N Made or IIeA <br />sed 9"ft Ugnamw reRiNes Me RRIVER nsr <br />q daily that to me p rF a <br />mne. OF rM work for nhhF IN, Somali a sued, I shill not nnplay any peron In wish memnn <br />M, to Ine,mq�Qy/ ybl�°��n �wk/m,P'P's GmpmwNon 1 of California... <br />Signed. ✓T` .--XlY __ —_Owner <br />BY _.Tell, _._ <br />m other than awned <br />WR DEPARTMENT USE ONLY — <br />APPLICATION ACCEPTED BY %' �/"-'!mss' .... DATE_" _. <br />BUILDING PERMIT ISSUED _ DATE t1YPY <br />ADDITIONAL COMM <br />MES _.�fA+"l`d°� X' Gg L r3?!. <br />Final inspenw by, NSlk ^ "^^"' Care O' JT <br />SAN JOAQUIN LOCAL HEALTH DISTRIO <br />E. H. 9 1/68 Rev. 5M <br />