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FOR OFFICE USE: <br /> ^ � ` <br /> �������\����� ���� ����[���l���U ������� Permit No , <br /> = � <br /> ~ <br /> r�~^r�'~ in ~r~~'~/ Botm |omxe6 ~ ` <br /> r From Date U <br /> _-_--_' This it , <br /> Applicationmade to the San Joaquin Local Health District for m permit to construct and install the work herein described. <br /> This application | 6e in compliance with County Ordinance No.. 549 <br /> Owner's Numa-'-' L'F.5--'�_��A J S.8.R Q C--,.--EKj Q -------x--O. ------------------� ro*ne------_--...-.-'-- <br /> �� K� ��� �� ���� ����/����' <br /> �66na��---_.�-»-�'~.'__-'*~e..'��----'����.~~^--.~.....,-^..�'"-".=='"--_--.-.---------'-----'-''''''----------'''---- <br /> Confroctn,'s Name---------42»AJmu ��::K _.___...____.___.________._______________.... Phone................................... <br />' <br /> Installation will serve: Residence Z3- Apartment House 0 Commercial [] Trailer Court [] Motel [] Other [] <br /> Number of living units. _J_ Number of bedrooms '3.. Number of 6mfhu %Lot size ` <br /> ---------------------- <br /> Water <br /> '---_--'-Wwter Supply: Public system P(�� KW <br /> 0 Private Depth To Water Table �� ft. <br /> soilf� a depth *�� feet: <br /> Sand <br /> ��m,mmf�r �� �� Gravel [] Sandy Lnum 0 Clay Loam [] Clay [] Adobe C] Hardpan [] <br /> Previous Application Made: (if yes,date-------- -----------) Nou;~~^Ne^ Construction: Yes &~l4o [] FHA/VA. Yey No [] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> ^ ~--~_- ' [NmwopNc'tan� orcm�pmm| pmr,n�fw6lfpu6rcsewer ivovmi|m��mw�hin200fe�h <br /> � SmV <br /> ' ok� Distance from noorox+ weW.4�^�l-'Dis{unco from 6ounJw6on- �42 Mf i | ��0��u~�e. -- <br /> ! No. of compartments-- 1> .-_-..Gro.3'AIRX-5-'Liqoi66eF�h-. ------Cmpad+y.IVV'�R...... <br /> ^ Dis | : Distance from nearest weliC~KVW.-_ fn�m �m foundation <br /> It Number of linesLength of each of french-- <br /> ^ t ���/ype of �|+or muto lo| R ��~K-Depth of fi|+or material '��-*I--^--]� u| |ong+6 � wK�� ....... <br /> '- <br /> -'----------- <br /> Seepage <br /> _ ~~U <br /> ~ <br /> Pit [��+once +o na�ro,+ woU--.-----.Dis+oncm from foun�o+|on-.--..--_�ld�ncoto noora"+ |o+ |ina-----' <br /> [1 Number of p�s---_--.Un|ng material----------------------- Diameter----------------------- '^ <br /> Cesspool: Distance from nourm, well----------------- from foundation-------------- material-'_----'--'-''- <br /> � . Size: Diamete, ----------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> .�� <br /> ' Distance from nearest well '''_''--'-'''-''--''Distance from nearest building'-'--_---_--'----- <br /> [] Distance to nearest lot |ine-------._------.__..._-.--.-__.-__--_______________� <br /> - <br /> Romo6el|ng un6/q, repairing :-------------------------------------- -----------------------------------------------------------------_----'----'—'---''°�� <br /> ''--------'--'''---'------------'--------'-------'--''''--'---'----''-'--------'--'''----'-' <br /> ---- ---' <br /> -_--__'._--._'--_-_-.-_-__..__.----'--'_'-_.'___'__.-- ---------------------------------' <br /> --'—`------------`--'---------'`-`--- --------------------------------------------------------- <br /> I <br /> ---' ----' —``— <br /> ' prepared �� a� � t� w�kw� be �n � a�m�a�e �� S� �a�� Cm�� <br /> ^ mr6�' '---S^�te laws, and rules and regulations�'�' -- ��� ' ' 'mf The San Joaquin Local Health District. <br /> ' US;@nedL-_-�.-_ .J����.�-. ---.-------------------.kO*nmr and/or Contractor) <br /> . ' � - <br /> __.______.__.______________________--''--''-_''_- /n��''---.-'—_-'-----��—�'-- <br /> | �� '. �*� �� wf�� ��� � ��m � ��� � wells, ���� �� c� be �-� �n ��� side). <br /> . ` , �� r~'' . ` <br /> > � `O°` =^'~°~'~"^°`' USE ONLY <br /> / \ <br /> ' /\PPL]C&TKON ACCEPTED BY----V-1.KtP"------------------------------------------------------------------------ uA/E-.------- 6-~��._.---- <br /> . RENEWED 8Y------------------------ -------------------------------------___--------------------------------------------------- ... o*|E--'-_---------------------------------------- <br /> ` ~ <br /> BUILDING PERMIT-ISSUED DATE_--.__._-----'_—'--- <br /> _' '���. ' ' - — '--''_-'' -'--.- �����---'�� �� <br /> ������ ���_�����*��» <br /> -_.. ---.�.-�.^����w���.-...*=�������-�s.,.�s=,�-.���."�«.u'c .--^xv.:.,.x�=^- .^-. , <br /> --- --- -------------------------------- --------------------------------------.---.----_-.--' <br /> -''-''''-''-''---'-''-''--'---''-'--------' <br /> -'-'_'---'------- <br /> ` /�' _�� <br /> '^ �N/\L |NSP �-. Dot�--����..�.=.�����"��----._---_.. <br /> ~ \ -�---- `~~~- ' <br /> / SAN JOAQU|NLOCAL HEALTH DISTRICT ^ . <br /> � ~ <br /> 1510:���x� �W��S� 1�*��x� n�W��S� <br /> California Lodi,California Manteca,California Tracy,CaliforniaEt <br /> � ~ <br /> - � <br /> oso v-on am e�uc xr�x� <br /> . ' ^ .--_ ; <br /> ^ ` , <br />