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' V~"_ ~~- <br /> /��p��{���\���� ����[ �����lT�T|��y� p�����T Permit » <br /> '` ^ --''''------ <br /> APPLICATION <br /> in OwpKcafo Date |��n6 <br /> _ <br /> llp <br /> __ <br /> Applicati6F is ereby made to the San Joaquin Local Health Dist rictA a permit to construct and instal work herein described. <br /> This application is made in compliance with County 9,rdina/e NoQ#. <br /> Ph on. <br /> 4------ -- --- ------- <br /> `'==r's '`a '=-------- t_, <br />! Installation w0 �6,vo� Residence M�uov LJ /�/ L� /r, E3 Motel ��� °"=" <br /> |n <br /> ^ ' � --'--'-- <br /> Nu�b� ny ||�nguni�' . N K� of6ed�mm's�_� �mum6a, � 6.aH� �'0 �t �e __'-_. <br /> ------- <br /> Water � <br /> Supply: Public system RR"Community system El Private [] lJeo+6 toWater Table H! <br /> Sy [ Clay [1] ��e �o��n E]���� of soil to a depth of 3 � <br />! ' `Previous Application Made: Yes F-1 ',�� ' Yes E] No [] pHA/VA YoEl No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: S <br /> `N- septic, tank . permitted <br /> I wellDistf'o, -------I Vafer <br /> 7� _'Siz ---Liq,i6 cl,p�h--- ----------capacity)�� <br /> Di Tal F` I isfance from nearest well------------- --DisfancArom foundation--------------------Distance to nearest lot line---------------- <br /> Type of filter material <br /> . �e, poo � � D'^'a"°" "~^ '~`'~' ^~'''---'-'--tance-- from - m� <br /> -- ' Size: D�mo+ec''�' �----'-��-.i.Depth_--_-�.__-._--'-�_..�quid <�upauit�.---'-''--g . <br /> �� ~ . <br /> ----------------- <br /> | . --- - -------- ---------- - -------------- -------------------- <br /> 7 <br /> ------------- <br /> I hereby certify that I have prepared this application anAthaf.fhe work will-be done in accordance-wifh San Joaquin Coun <br /> Septic Tank Ser.Wce <br /> (Signed)--- <br /> ` ' <br /> (Plot plan, showing size of lot, location of system in re afio to w buildings, can be placed on reverse side). <br /> / r.rru�^/�"` "^`,^, .�" ". <br /> -'''`�`~~''^^~~_'-'-'--_'---'-' � <br /> ' <br /> APPLICATION ' DATE/ REV|EVVEDBY.---_-__._-.��--_-----_.----'___--_'_--__ -__-__.______________ <br /> ' �*|� <br /> BU|LD|N�� PERMIT ISSUED.-__.''''-'''_------'`'-'--~_�''---''-''''--- '''--''---_'--__'-'_____ <br /> A�n,aMonsmnJ/nrrwcommen6at�"* -�_--._----------_---__-___-.___.-.__----�-.___.____-.. <br /> ._.__--____---_--__- --------�--._--_-_._------'__-__--._-_'-__.__._--. <br /> -'_-_--'-------'�--'''----'-__'''''--''--''--'-�-_-''-_''''__''''--''----'-__'''''--'''------'_-.. <br /> - �` -._----.-'_-_--._----_--_.___-_-----_.__.-.. <br /> '--� ��� <br /> ' <br /> - - Dvte� � ' - ''--'-''-' <br /> RN�L |N�p��||��m uy '-'- '-'�'''-'7°—''--''-''-- <br /> -' `"SiXN <br /> JCAQU\NLOCAL HEALTH DISTRICT <br /> /ou South American!a��C ° . aw West Oak ��«m. ' /a� ~'~ <br /> m"= S�°� m* wv�6 "C' <br /> Street <br /> e""uo". om|av,"|^ n� " '-L4. California M^nm^°. California Tracy, California <br /> ` ss-�-aw . n=�°a1'ur �p�o <br /> ^ <br /> ` <br />