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, \ <br /> FOR OFFICE USE: <br /> AP����� �� �������� ����� �r� No. <br /> � K <br /> t+ '---- \ <br /> ^�m-�o-� � C�n-----------------' —` y ' <br /> Date,Issued <br /> ---------- <br /> Application is hereby made to the San Joaquin Local Hou|fh District for m permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549.0ess - <br /> JOB ADDRESS AND PRjIKTI67 <br /> Contractor's Name. <br /> Installation will serve: I"t t <br /> Residence Apartment House E] Commercial Trailer Court 0 Motel Other <br /> Number of living units: Number of.bedroomsJ----j��mber,otl�aths ----/. Lotisize ................. <br /> Water Supply: Public system mrnun'it�;systei C] Private E] De I th to Water Table6j ft. <br /> Character of soil to a depth of 3 feet: Sand In,I Gravel Sa ndy Loam Ll Clay Loa [j Clay [3 Adobe @__�Iardpan 0 <br /> 4 <br /> Previous Application Made: (If yes,date-------- ---- No [] New Cons, ru�t, Yes El No E] FHA/VA: Yes El No [3 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS-1 L�� , <br /> (No septic tank or cesspool perr�itfed if pub ic sewer is available within 200 feet.) <br /> Disposal Field: Distance from near st well.-Tn <br /> T pe of filter rna ------Depth of filter mat'ri ... <br /> Seepage Pit: Distance to neares4well from founTation-1-14.0 bistance to nearest lot line__S'_" <br />� ~��*����� . � <br />. 0 Size: Diameter-------- . ---_--p -------.- ` <br /> rrivy Distance from nearest well T_ urta <br /> | haveprepared \`v <br />` ' ' . . <br /> ==.a"°=~ °.~.e laws, and rules ~..~ regulationsof the San Joaquin L�cil Health District.0 <br />- r�=°� <br />/ -------------- <br /> ot plan, i�owiinq-size of lot, �cw+�n ^�°*°� <br /> fia�� be laced on reverse side). <br /> in.,r6lition to wells, buildin S, etc., an <br /> If-FOR. DEPAO MENT USE ONLY <br /> _� � <br /> APPLICATION ACCEPTED BY''°�.x.�� ------ ---------------------------------------- DATE------ ---- <br />| <br /> REVIEWED BY----------------------------------I & --_---_-_.-'--'-''-_-'-_-_.--- DATE............................................--.............. <br />' <br /> BUILDING PERMIT ISSUED DATE -'--'---'''-----''----'- <br /> --- ----'' <br /> --'--'-----''-----'-'''--''--'''-'''-'-''--''-'-''--''--''''--''--'-'-'--'--''--''----'------' <br /> --''-'-''''''-'-----'''--'--''-'''-'''--'---''--''---'---''--''-''-'--''-''—''----'-''---' <br /> _ _�-_ - /� �� <br /> R � <br /> FINAL INSPECTION BY ..�.�. .��----------------- <br /> Dut�...~ -..u7+--~--- --------------- ..................... <br />� SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Svr*of 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tra(y,c"mornia ' <br /> = ° ""VI""" "°" *M 5'61 ="`° <br />