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APPLICATION ��� ������� Permit No. . <br /> \\ P~onp/ero in wwp"="`=/ ee <br /> Date |,oxsd -- ' <br /> / ' <br /> > ' made to the Son Joaquin Local Health District for o permit *zcon,truc-t and insfa||the work herein described. . <br /> This application is made in compliance with County 5rdinance No. 549. <br /> Installation will serve: Residence R;4--Xp-a�rtent­House E] Commercial E] Trailer Court Motel El Other <br /> �Num6er of living unit,: -/- .-I---- / <br /> Number of �o�n,om� Nvm6e, of 6u+�s .- Lot size -- �� . -�--- , <br /> ' Supply- Public ,yoh*m El Community ,y,�.m [] PHvuteJE1°~Di`H` to Water Table -'- ft.' ' ' 'm@ to a depth of 3 feetSand Ej Gravel F1 Sandy Loam El Clay Loam 0 Clay El Adobe L] <br /> Charaaer of <br /> Previo6s Application Made: Yes E] No [9�ew Construction: Yes e-�00 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> k or cesspool permitted if public sewer is available within 200 feet.) <br /> (No septic tan <br /> Septi Distance from nearesf we�l--- Distance from ------- 6- <br /> 1�k i -, --19- <br /> bispos"al Field: Distance from nearest well_�6_0----.-Distance from foundation---LO----------Distance to nearest lot line.__�_�---- <br /> S+_Width of french <br /> Type of filter maferi&I__'5T7R\ --,Depth of filter material....i�7' ---------T <br /> Seepa�e Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot.Iine____,.--------- <br /> FPDistance +onearest lot Iin"''' ---------------- ---------------------- -----------------------------------------------------------------------------------------'� <br /> ` <br /> repairing (describe):-------------------------------r----_.-__-'__.''-_.''----''-__''''----_-.-'''_---'--' <br /> --- ......-'------------------------------__'----------------------------------:---------------------.__-'-_---------------------- ------------------ ------------------------------------- <br /> ---------- <br /> �--__-__---.__-_-__'___-_--.-_._.____-_-_-.___.----_---.___._--.--__-. <br /> -'- <br /> I!hereby certify fha+ I have prepared this'application and that the workwill be done in accordance with San Joaquin County <br /> ordinances. Sfafe,,17s, and rules and regul9jions of fh&.jar <br /> ,Joaquin Local Health District. <br /> (Plot 1p�an, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> ' <br /> FOR DEPARTMENT USE ONLY <br /> APPLILATION ^CCcr/Ew B/--- ------- -'_'-'-- ~-'-''--'''__-'-''' DATE--''''--m'--'`------ <br /> REVIEWEDBY------------------------------------------ ------------------------------------ -_-------------------------------------- DATE----------------------------------- ---- <br /> __.__ <br /> BUILDING PERMIT ISSUED---------------_''''--'�-''_-''-''-'----'''-''---'''-- DATE------------------------------------------------------------- <br /> Alterations <br /> wn6/n, ,wcqmmon6u+ionw:-------------------------- ------- ----------------------------------------------------------------------------------------------------------------------- <br /> --------------''''''--''---''-'''--''—'''-'''—'''--''-'-''--''''--'''''-'''--''--'--''-----'--- � <br /> ' ~ <br /> -'�-r-'------'-----'--------'--'---''--''-''''--''---''-'''�---''----''''--'''''-----'----'---- <br /> -------------'---'---'---------------'-------------------------------'-' <br /> -''-'-''--''''-''--''''- ----------- -'---''-''''''''-''''-,''''''''_----- <br /> . --'''--'--' <br /> i - <br /> FINXL INSPECTION 8Y:. Date.......4�7�'u�� <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT ' <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California �Tr�v California <br /> ES-9-2M ' x".is"J vv-2/00 <br />