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A <br /> ' ������� �� ������ ���� ��M �. US � <br /> � - A���o�+e 7n �wu�c�+a <br /> " <br /> (Complete Duplicate) Date Issued <br /> Ann|ico6un is hereby mode to the Son Joaquin Local Health District for u permit to construct and install the work herein described. <br /> This application_ is -_- - _',_' ' - _County - - -- - 549. � <br /> K---1.44+2 A <br /> ' <br /> JOB ADDRESS AND.LCCATIO - 1�------------( -------- <br /> ` _ _ <br /> Con+nocfur'v Name-----_�^�0. --------�-..-t---------------------------------- I-------. Phona.---------------- ---------------- <br /> Installation will serve: Residence /\porhnun+ House E] ' Commercial 0 Trailer Court [] Mnh:| [] Other [] <br /> ! <br /> Number f living units: I Number f bedrooms Number f baths � Lot <br /> ) <br /> Character of soil to a depth of 3 feet: Sand [] Gravel El Sandy Loam El Clay Lo <br /> lk,. la Adobe 0 Hardpan El <br /> es 0 No <br /> Previous Application Made: Yes E] No M, New Construction: YescpR No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ee V' <br /> 14 �av <br /> ' <br /> (No septic tank or'cesspool permitted if <br /> Septic Tank: nearest well -clit/Pis an e om ougdaf;on---- M t r'ale�4_v - ---------- <br /> Disposal Field: Distance from near t well--- --- Distance rom founda Distance to nearest lotiline- -V-5---------- <br /> wc� '°"" b=' of ""=^ '�+ <br /> | q* ��er --------------------- <br /> m <br /> n��n / <br /> \ '. .-� <br /> � Soepug* Pit: N 6e of p�s <br /> Co,,po"|: D�,h,no, from U _~r~: <br /> El 5br: Dia <br /> Privy: Distancefnom L <br /> Distance ���r�, tmi|d�g'����-��'-�-_��'''_ ' r~ <br /> D�funcoton�ono� ]of |inu..L-.----.-----_--_---__--__.----------------------------------------------------------- �~ <br /> , � ^ <br /> ' <br /> Remodeling and/or repairing (describe)--.-'�---_--_-�-----__-'--__..___--_-------.---__.___-'_.—_--' <br /> ' <br /> -------''---'--�--'--'--'''-------'---'----''----''--''--'----'''-�r--'''-'--'---''-'''-''---''- <br /> � ^--.—__-___-_--______-`-.__-___--._—________--__...__.-_'-�-_._._.__._-��_----. <br /> � —''�--_-'�---'---.---'''__.''_-_-'_----__--_''___'__.''-_''-_--,--!_-._--`'--__.--''''-_'''-'--' <br /> | hereby certify that | have prepared this application and that the work will be done in accordance with Sax Joaquin County <br /> ordinances, State |a*s, and rules and regulations uffhe_San Joa.quin Local Health District. <br /> �S�gne6i._��.]�. -.��--- ------------------------------------------------------------------ 6/orCwntram+nr) <br /> By:---A .__--.__.--_..-----.. _--__._--___--_---_-Title <br /> ) <br /> xlan, showing size of lot, location of ms+em in relation to ~ells, buildings, etc., can be'placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> . APPLICATION" . ACCEPTED ~ <br /> ' - <br /> . ~ <br /> _~c���-.��~�`��u4�.—.'p�o�-.�^*.��_'-_��-_4r�m-��'��--_-----'_-._-._._.-'--- <br /> -------------------_'---'''---'''-'''--.'''-''--''''-'_----'''-_-'---'''--''--'-''''-_''-_--'-'''--'--'�-''- <br /> ______________________________________________________�______�______�___�_____________���________ <br /> ` <br /> FINAL INSPECTION BY:-''''---''''-''-----'''-''''-' D°t^'���------------ ----- ------- --- ------ '�-'-''-''----- <br /> ` . ^ SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street /32 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ' <br /> ES-9-2M ' Re~a°w 1`57 r,poo. <br />