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7 n�� u��� . <br /> -- ------------ 1;)-- APPLICATION FOR~ ` � S�`�� PERMIT 4111 <br /> �� <br /> ---.� �� �� -_ . <br /> ;n Qu���r� Date |�ow� <br /> ----------- --------- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health Dist rict for a permit to construct and install the work *ein described. <br /> This application is made in compliance with County Ordinance No. S49. Ave,ir e-,u 40 0 17e�r -,4- <br /> JOB ADDRESS AND LOCATION <br /> . � <br /> `'°"= = Name.._--- ~_�--^ - � <br /> ����� '-___-.-.____--_..__-'-_-.--__-_-__ <br /> �p"'="�-' -� -- ---------'� 5-3 -7 -6- �~� <br /> Contractor's Nu�e.^��� __ _---.-----._ Phona._--.__.�����r / <br /> Installation will serve: Residence d- Apartment House CommerCommercial [] Trailer Court [] 'Motel <br /> [3 Other <br /> [INuo6n, of living units: +/-.. Number of bedrooms .J. Number of6mths L' Lot size . =X- /x. .................. <br /> -''----' <br /> 2- ft.Supply:�: ��|c system 0 Community system 0 p�� K �� � Water T� <br /> Chmnmctermfsoil f� wdepth of 3 feet: Sand [3 Gravel [] Sandy L"amA Clay Loam [I Clay E] Adobe[] Hardpan <br /> Previous Application Made: (if yes'Jote--------------------) No o1 Nm* Const,uction- Yes g No [] FHA/VA. Yes 0 No 171 <br />( <br /> TYPE OFINSTALLATION AND SPECIFICATIONS: ~ ,x <br />' /NmxwuM* fmn� nr ��w�m�| ��rnoMf�6 if �ub|l�uewmrismv^�|m6�vvi+6in20� fmwf� <br />� ^ ' / ' <br /> ' y ^ <br /> '_ � _--.-._ <br /> Septic Tank: D| + ,nowell--,3,V Distance f foundation /�� Mutn,io} -_ <br /> Disposal F��: Distance from Distance from .o"=a" <br />' ' ' � trench <br /> Num�or of Uno, -- �- ''-'''Length of each line l�e� - v |u� c ' <br /> Type of filter moteriaLT^va k~------Depth of G|h,r material -/�.�--'_Total lengtn-. ........ <br /> Seepocie R+' Distance to - res ---. uarance foundation -D�tunca +o ._- <br /> �at | |�o~ Number of pHs-.~.*�----------U Lining mu+eri | ��.^<~---Size: Diumoto, . Depth----1114-1z �� <br /> -.- <br /> Cesspool: �i�unoo from noune� well----------------- from foundation Lining muta�oL--._-'-_.-__- <br /> - - Depth Uq�6 -_.gu/� <br /> [� S�a� D�metac._-.---------`m_---._._-------'—'' ~~r~~',------ <br />| privy Distance from nearest well '''_''''-----_''' --- ---Distance from nearest building----------------------------------------- <br /> El <br /> Distance tonearest lot line'''---''''-'''-''--_----------------------------------------------------------------------------------------- _ <br /> Remodeling and/or repairing (doocrba):-------------------------------------------------------------------------------------------------------------------------------------------------------' <br />| .__--_..- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -__-_-___-_--- ------------------------------------------------------------------------------------------------------------------- -------------------------------- -------------------------- <br /> _- _--___-'-___.-----.__--_'-..___.---_-___'-_--''-__-_---''---'-'-' <br /> � '------''---'--- -I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances. State laws, and rules 7�d regula+ions of the San Joaquin Local Health District. <br /> (Plot plan, showing size of lot, location of system in relation to wells, buil.dings, efc.. can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> urw�_' <br /> BU|LD|N�' PERMIT ISSUED__'_--' .-_-_.. <br /> . A�erm�onsmn6/or - -�x_�.�ww.u�'==^��.---' -------------------------------------------------------------------- <br /> ----------------------------------------``---``-----`--`---``�``����---````---``-------------------``----------­­------`--------`-----`-------------------------``-----------------------` <br /> -------------------------------'--'---'-'---'---'--'-------------''----'—'' <br /> � ' -----------------'---'����...........''..^­­------------------- -------------------- ------------------------------------------------------ ------- ------------------------------------------------- ­ <br /> ------------------- <br /> I <br /> _ <br /> � .---_--'--'-------''------''''---'-_-''-'---''' -''-- -- <br /> � <br /> �- <br /> ` �`� �� - <br /> RNAL INSPECTION BY��� �-��������..��-------. "�.°`-----_.---------------....... <br /> , <br /> U <br /> SAN JOA9U\N LOCAL HEALTH DISTRICT <br /> om�wwmw"�� � 1r*Sycamore o*°� uwmWwm�*s�w, <br /> ,»��°�����n=."e�� "* <br /> Stockton,California Lodi,California Manteca,California r=='Canfo,"/" <br /> cn y ncv/sco n'59 zm 5'62 ^,Lxs <br />