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_x�^ APPLICATION FOR SAN �� � PERMIT Permit No. ..... <br /> (Complete in Date Issued <br /> cJ c��n is hereby ko � mode to Health Sun Joaquin Local Hau� District for u permit to construct instainstallmninstall ��v�rk hereindescribed.T�|' � <br /> �� o� is 6 in |i with County Ordinance No. 549. S7� <br /> Installation will serve: Residence W__<artment House 0 Commercial [] Trailer Court E] Motel [__1 Other 1-1 <br /> Number of living units: I----- Number of bedrooms 2--Number of baths I----- Lot size --------I? <br /> Water Supply:, Public system El Community system E] Private al��Pto Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel-E] Sandy Loam E] Clay Loam E? (5a`y El Adobe 0 Hardpan El <br /> Previous Application Made: Yes E] No W-1�11 Construction: Yet[�,�� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sefer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well--,-.7_ dFislianco, from foundal.ion-j/-6- M to 'al -------- <br /> Disposal Field: Distance from nearest well ..V.-Ftstance from foundation_.��---- --Distance to nearest lo ine-_ <br /> Seepage pilt. Distance to nearest well f M <br /> ^ Rnmoda|ing and/or repairing (da:cribo):-------------------------------------- --------------------------------------------------------------------------____.____._______ � <br /> -------------------------'--------------------------- ---------------------------.--------------------------------------------------------------------------- __--.----_.___----.. � <br /> —'''-'--'''--''---''_-''_-'--_-__---'-_''--'_---_--_.'''----_--__.''--''---_.-_-.'�-'---''-�*� <br /> -- ------------------------------------------------------------------------------------------------------- ------------.��---.---------------.---.------------------------------------------------.------------------- <br /> I hereby have prepared this application and that the work will be done in accordance with San Joaquin County �� <br /> ordinances, ,u|oo d M| of the San Joaquin Lwuu| Health District. Z! <br /> -�` �.� ' <br /> (Signe6L.L.. ��'.=t^�I--------.+��!.. ^-- -------------------------'�Ownmrand/or ��on�a*tn� �~ <br /> By: �N� <br /> -__-.------'-'---------------------------------'` '---------------------'- <br /> 'Plot plan, showing size of lot, location �� �+ein ro|*t|*n to wells, buildings, et*.. can be p|mwe6 on reverse �o\, ~�' _ <br /> FOR DEPARTMENT USE ONLY <br /> AJtm,atiwno and/or recommendations:------------ -------------- --------------------------------------------------------------------------------------- ----------------------------------------- <br /> -------_--------------------------------.-----------------_-'_--_--._-.'_---_--.- <br /> -._-----_--._---_---------------------_----------.-'---_'-_-_--_--____._.. <br /> --'-_'--''''�'—'--'_-''--'_--'—'''--''�--''_--'--''_''---'--_--'''-''-'-----''---' <br /> --'''-'--''''--'''--�'_''''-''—_--.''--''-'''_''--''--''--'''_-'-'''-''-'' =' '------' <br /> FIN/\L INSPECTION nv�r« ~������ _---' D*+o --'-���--�°�-''—r���-------------------------------- <br /> A_7 <br /> '-''-'---'- <br /> -.�'—� ''-'—''-- ^� ' ' <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> oo South American str°°+ 30D West Oak Street /sz Sycamore Street 614 North "C" Street <br /> Stockton. California Lod/, o°|ifo:r"|* Manteca, California Tw^,. California <br /> E"-9-2w ,~~°.~°""" ``"^ <br />