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FOR OFFICE USE: <br /> i ----------------- <br /> APPLICATION F���� «�X�|[��TI���� PERMIT PermitNo. <br /> - ----',� LL� 8Cm�w�� � Om���l ~- Du� |oua6 0- sole- <br /> ------- <br /> ~ <br /> � '"6 � <br /> Applicationhereby made |� �� f� � � install the rk herein <br /> This application is made in compliance with County Ordinance No. 549. <br /> Installat.ion will serve: Resiclencel�l Ap;rfmAt Hou'"se [] Commercial E] Trailer Court E] Motel Other <br /> Water Supply: Public system C) Community system El Private LAr--Depth to Water Table --9F--Wff/6 <br /> Character of soil to a depth of 3 feet- Sand [] Gravel E] Sandy Loam �K Clay Loam E] Clay E] Adobe [] Hardpan n <br /> Previ ous Application Made. (if yes,date.......... ---------) No New Construction VA� Yes No Ix <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted' if public se-ri r is available within 200 fee+.) <br /> ou <br /> Dispo;al Field: Distance from nearest well--- Distan'Ye'f�ro!YfouXn�atio,---/-P---------Distance to nearest lot <br /> Number of lines--3 g::2�. -----Wr---Width of trench <br /> �7 Seepage Pit: Distance to nearest well- ------Distance from foundation-----ak 4�.Distance to nearest lot line------ <br /> ID <br /> Remodeling and/or repairing (clescribe):.-Z�m-Z9�--- <br /> -------------------------------------------7------------------------------------------------------------------------------------------------6)----------------------------------------------------------------- <br /> ---_-_-------_---_--------..___.-----_-_-__-__-.--_------.--.--_-_---.-------- <br /> . that accordance with San Joaquin County <br /> ' o"na""=, °a. .. . ~-_-. Health_ District.— <br /> --J��� 1?;�����^�����.�---_-----------------(Owneran6/n, Cnn+nont*r) -� <br /> By:-_.__-_--__---'--__-_----_------_--------../Titlei._-------'_------_--- <br /> ' <br /> (Plot plan, showing size of lot location of system ;, relation to ~o&o, buildings efw. can be placed on rw"e,a, side). <br /> ' <br /> . FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY'------------ _-_' . DATE_ �-- ----. <br /> -_--BREV|Ew�BD BY----------------------------------------------------------------------- D/HE'-'����^��-- ---------------- <br /> BUILDING <br /> U|LD|NG PERMIT ISSUED-----------------.--------------------------------------------_--'^ --- ------'-----'— D/ rG._---'---'_'--'-----__-- <br /> � -A-|te.,ofionoan6/or ,ocommondwMono:-------------- ------------------- -------------------------------------------------------------------------------- ______________ <br /> -.-----.__-----.—.__--- <br /> \� _------_- '—�-._-._----------.--�----'__------ -_''�-_ <br /> --'''''- .-'�''''---''''-'-'--_-' <br /> '�'/--_.'�'�-�'�',-_—_' <br /> -'—'-''-__'-'' <br /> --�---'---''''-'''''''�''-''-'---'---'''''-'-''-_'--'''-'_'''--'` —'-''_-''�-~'''--'--'''�'� ` —'-�'-_-''--'-''''���_'''�---''_''' '_---''''_-''''--'''--''''—_'--'�--'�----' ---------- <br /> -------------------------------------------- <br /> -'-' <br /> -''-'--''''--'—' <br /> LDate <br /> |N�PE{�T|(}N QY�-'''�������������..��?���.�----' D*f�----._-------------------' <br /> \ � SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> t `wwvm*",ello"Mt. x0uWest Oak Street u*Sycamore Street 205 West 9th Street <br /> \ ` <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> 8'S9SM33`63 F.~=". <br />