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FOR OFFICE USEI <br /> --------------------------- - ------I--------I------- ;This Permii Expires 1 Year From Date lisued T <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compli�nce )yith County Ordinance No. 549. <br /> --------------------------------------------- <br /> Installation will serve- Residence [] Apartment House 0 Commercial j:] Trailer Court E] Motel Ej Other <br /> Water Supply: Public system El Community system [I Private E�'Depth to Water Table 4�1__ ft. <br /> Character of soil to a depth of 3 feet: Sand Ej Gravel [] Sandy Loam Ef Clay Loam E] Clay E] Adobe ETHardpan El <br /> Previous Application Made: (If yes,date---- --------- ------) No B^~ Ne* Construction: You ' o E] FHA/VA: Yes E:1 No ET'-- <br /> TYPENSTALLATC)N AND SPEC|Fk�ATkONS; ^ <br /> �(Nwse' �� tark°°~' ermitted if ^ 1 - is �vwUm����h��200fowt) I <br /> , ool � <br /> So Tank: Di�+uncn from nearest Distance from foun�otion/x�--_--��u+oriaL� ------- <br /> '`" of "'"'pa'""ents__:`=�-----------------S'°= v� `~r- ; --r---, ----- <br /> Disposal Field: Distance from near well..�'� Distance from Joun <br /> Seepage Pit: Distance to nearest ------------Distance4rom foundation-------------------Distance to nearest lot line----------------- <br /> ,",v' Distance from ==s' ~~^ ^' ~—'~' ^~'^' nearest ~ <br /> ��� ~- <br /> + ' <br /> -_-'-'_�''-_--'_---'''.__-'-��--��- -'--,�_-'_-.--_-'''--.'''''-'-'_--'-''-'-'�—' <br /> -------.-------.�--.!--_--.'�...--.-'~.°~-��°�----.---'---_x----.--__---_-.-------.-----------. <br /> [ ________.________ _ '_____.__._�_.__._____..�__.�_--__-----__-__.---.—.__----. <br /> I hereby certify that I have prepared this application and H, the work W� be done ` a'ccordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local H-alth Dlsti�*�f <br /> . ~r-------..----., -�� .~ -----.-�_._-_-- . '-------------------- <br /> (Plot plan.p|wn. ��ln� �� ��� �m�n � ��� �n ��. b����~ �n � �� on n�� side). <br /> . , <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.'----_^'-'_---�----'--'--_�__.-'-_-'- DATE'''--'--'-'-''---'-'-'-'— <br /> / ^ KEY|EWED RY-----------�'-'--'--''-�---_--------------------------------- --- --- -------------------------------------- DATE -------------------- <br /> BUILDING PERMIT ISSUED---_------.-----.. u/*E�..�a-�e����-��.�----._-- <br /> [ AK�,uHonu and/or ,m���mrn6a+�no�--.------- -_---._..-_-____-_.__-_._________.. <br /> . . <br /> ---------------------------- ---------------------------------------------------- ---------------------------------------------------- ----------------------------------------------------------------------------- <br /> -------------''''_-''---_'---''-,''--_''—'''-''-''-_'''-_.�'-_''''------''-_''_-.--`.-'---'-'-_-'--' <br /> . . ^ <br /> '-'-''—_'''--,'---''--''-''''--'--'''--'----'''-_''---'''_--'--'''-''''-''''---'''_-'---- <br /> .—'''--'-''''----- '_-'''-'''-''''-''-_-''_-'---'''---.--_''-''--' <br /> FIN/\L INSPECTION BY:--------*��'������-°��F��y�^�°�.- Dw��----.�--'����--�r��^�'�-�------ <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> 1601 aHazelton Ave. ovvWest Oak Street 1u*Sycamore Street eusWest 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> =" 9 REVISED 8-S9 =° 3~6» r.P�CO. 7 <br />