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Jr. ^ <br />(Complete in Duplicate) /0 <br />Applicaifion-is'heV y"Wade to the San Joaquin Lo�al Health District for a permit to const c InAMW_6 work herein described. <br />jA <br />rc <br />JOB ADDRESS fD LOCATION -- ----- ---- <br />Contractor's N m- <br />-installation will serve: Residence E] Apartment House E] Com�nercial E] Trailer.-Courf I/motel Otber [I <br />Water Supply: Public sysier 0 Community system El Privaute YDepth to Water Table --o-. ft. <br />Sandy L <br />Character of soil to a d4th of 3 feet: Sand 2] - Gravel 0 odim Clay Loam E] Clay clobe Co liardpan E] <br />Previous Application Made: Yes M, No 2/ New Construction:' �PNo F-1 <br />TYPE OF INST-AL61kTION AND SPECIFICATIONS:' <br />(No septic tank or cesspool permitted if p+rl� sewer is available witKin 200 fee+.) <br />Dispo4 Fie�d: Distance from nearest well-Z�'-.i9-O--Disfztnce�_fro'm foundation ---- --------- DiGt6nce to nealst lot line— <br />I hereby certify that I have prepared this application and that the work will be done in accordance- with San Joaq6 r�Counfy <br />ordinances, State laws, andrules and regulations of the San Joaquin Local Health Distric . <br />(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.. can be placed on. reverse side). <br />FOR DEPARTMENT USE ONLY <br />- <br />| <br />APPLICATION ACCEPTED _.__----___.— oA|E_ <br />REVIEWED 8Y ----------------------------------- <br />BU|LD|NE) PERMIT ISSUED ------------- ---------'---------------------. DATE --.-'����--.-----_-_---�-- ' <br />' <br />Al+o,of|vnx and/or n,commnn6aflnns:..:---------------------------------- ---- --------------- -------------------------------------------------------------------- -------- -------------------- <br />------------------------------- --'----------------'-------------'--'-----''-----''---------''--- <br />--_—_--_.___._.__—__._-----._-----�_.--'_—'_---_'--_--'--_''-_—'''''--_.___--'_-- <br />---_-'--'---_--_---�''__---''--'--'''_--'—'''---'—_.'---'''�—''�'----'—''---'''_,—''---_.'--'-��—~_ <br />___---_---_----_--__--_----'_--------_—_----_^-----__—.__----._-----_—_- <br />-` <br />FINAL INSPECTION BY:'+��_—'''--''—''---' Do+e'—'''/��/�c����p�'���--'''--'__--' <br />^�� . <br />S/\NJOAQU|NLOCAL HEALTH DISTRICT � l <br />/m South American Sfrea+ sooWest Oak Street /oo Sycamore Street uw w=+ 'zr Street� <br />Stockton, California Lodi, California w""tec°C°|a"rn|" Tracy, California <br />ES -11-2M 8a1 naviwd W-x/oo <br />- � / <br />