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FOR OFFICE USE: <br /> APPLICATION F6k'sA-NITATION PERMIT Permit No. .,� <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describeq. <br /> This application is made in compliance with County Orclinanqp No. 549. LZ <br /> A ------------ <br /> Installation will serve: Residence Apartment House E] Commercial [:]. Trailer Court E] Motel 0 Other Ej <br /> Water; Supply: Public system Ej Community system E] Private a Depth to Water Table J-Zft. <br /> Character of soil to a depth of 3 feet: Sand K Gravel [] Sa%iy Loam E] Clay Loam E] Clay [] _ Adobe [] Hardpan E] <br /> Previous Application Made: (If yes,date---------------- No [Er"�New Construction: Yes El No ET""FHA/VA: Yes D No Er—' <br /> TYPE-3F-|NSTALLATk]N^AND' NS <br /> (No ,optic tank or cesspool permitted if public sewer isavailable within 200 feet.) � <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material --_--------'--.- <br /> 0 No. of compartments------- ---------------Size------------------ ------------Liquid Joo6--------------------------Capacity----------------- � <br /> Disposal Field: Distance from nearest well------ ..-Distance from foundation...../.0---------Distance to nearest lot line­'--6--�---- <br /> I " r __e <br /> Seepage Pit: Distance to nearest well----------------- ----Distance from foundation--------------------Distance to nearest lot line--------1 <br /> 0 Size: Diameter.----------------- ''--------------Depth-------------------------,- ----------------------Liquid ~~r`~'/----'--'--g~'^ <br /> = <br /> Privy: D�tncefrom nou�s weU'�-�.��—_-'—'_-----D�+ ncofnomnoum� 6ui|6ing--''.—'-_-'-'-- - | <br /> [� Distance noom� |o+ |�� . � -------------------------------------------------------'--'--'-----.---_.-_'�'''' <br /> � - '� ' -- ^� ( <br /> Remodeling and/or repairing (describo):--. ---------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------- -------_--__----- --------------_-----_---_----------------_�'� <br /> / <br /> ._-.----_--.--._-_--_-.—._-_-------_'_' -_-----''—.-.-.-------.__-'-' <br /> ^---------------------------------------------------- - _ .-_--.-_-------_'-.----_-----' <br /> I hereby certify that I have prepared fhis":,ipplica�fion and':':,fhat the work will be done in accordance with San Joaquin Coudy <br /> ordinances, State laws, and rules and"ije�,gplafions of fhe�San -Joaquin Local Healfh-Disfrict. <br /> --(S—''—gn-ou)--_-u�V­2,-�� �._ -- - � �� ,-- ' -=���-��,-',�''`yO,�orand/or <br /> �onT�c'�--��' <br /> .������ �����',�� <br /> _________ __`____-___--'-'__-_.-_-.-'--- -(|mu).-.----_ - --- _-- <br /> ------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, etc., can be placed on reverse side).FOR DEPARTMENT USE ONLY <br /> APPUCATDNACCEPTEDBr- -_-------_..---.—_------ DATE' ----------------------- <br /> REVIEWED <br /> ------ <br /> kEV|EVB} OY'_---_''--_--'----'—.-----_-_'--'----'--''-- DATE---',-''----'�--- <br /> ---------------- <br /> BUILDING PBlk |T ISSUED.-_-----'------__''---___.--'--'-.---'-- DATE------_ --''------------- <br /> Alterations <br /> _-.- <br /> A�a,u�pm, an6/o, ----- ------------------- . . - . _--'_--'- --'---------------_--'----_ <br /> --_-------__'------_---- - ----_-.---' <br /> '-'-------42- <br /> ------------------------------ -T <br /> 1 <br /> ----------------- ---------------- <br /> � <br /> ----'' --'-''—'--'--__-------_'--_''' <br /> x � <br /> 6�l ^��� ' <br /> �N/\L |NS ..�'/� �-- Date'--'���������*�,c.~---------'—� ' <br /> - / <br /> SAN J0AQU|N LOCAL HEALTH DISTRICT <br /> | <br /> 1601 E.Hazelton Ave. � uoow"sto"kere" . m*Sycamore Street uo:West 9th Street <br /> . <br /> nm"kt"" California '' '' Lodi,California ` Manteca,California Tracy,California ./ <br /> rpoo. ' <br /> � <br />