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* ` <br /> ���� <br /> �p�Y\ �� ���� ����7 ��\m�r� . ~~.- _ . <br /> ^ ~ ^ --~��~"'^~ <br /> (Complete in Duplicate) <br /> is 6ona6v made to the San Joaquin Local Health District for o porm�t to construct and install The work herein described. � <br /> This applicaf*ion is made in compl.I iance wit,h, County Ord inance No 549. <br /> */3-------- --- -- I -- - ---- ----- ------ ---- ---------&V -4---------------- --------- <br /> 721 4Z <br /> Installation will serve: Residence V Apartment House Commercial 0 Trailer Court Ej -0---/------------- <br /> --- <br /> Number of living units. wu Numb~r of -'- -- <br /> - Number of baths [I <br /> Water Supply; Public system El Communitysystem E] Private Hardpan <br /> ^ n6vLoum � [ ny Loam Clay � �*� <br /> Character of sml| |wm depth of3foet� Sand F1 ��vo| [] So <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ~~ <br /> pubUosewo, �v availablewithln200feot� <br /> `No septic tank mrcesspool.por��ted � <br /> ' f �aU Distance f�un�nt�nn---_.----kJotariu------------------------------------------------- <br /> Septic <br /> .--------.--_'_---- <br />` 5opHcTuok: ^ Distance from nearest -----'- ��o Uqui� 6eofh-------'--- <br /> Co :�y ---- ' <br /> LJ �"� "."..~.~. __ � <br /> v ' ''`/ `- <br /> Distance to nv� mr /m�_- <br /> ' w�| Distance =" ."".�~.~.�_ --_ <br /> age Pit: Distance to nearest <br /> " Number of ."==.____________ , <br /> El p., --__-� ' -- <br /> At&'r-Distance from foundation---- --------Distance to nearest <br /> Disp I Field: Disi;nce from nearest we -------- <br /> Number of lines----------- Length of jach Ii <br /> Type of filter ma <br /> --------------------------------- <br /> I h--e--r-e---b-,y----c­e-­rf--i-f-y----f-h--a--t--I-h--a--y--e----p--r-e--p--a--r--e-d---t-h-i s- applicatiori and--f-h-a--f---f-h--e----w---or--k---w--i-1-I---b-e----do---n-L----i-n----a-e--c--o- d-- -n--c-e-----wit--h---S--a--n- <br /> f s of the San Joaquin Local Health District. <br /> � �r�man�ao �r*`� laws," ""~ .._- _- .-�-_ <br /> ion <br /> (Signed) ______-___________i|mm �---'— <br /> / BF--'�u^y�*"'--���- -'-- ~ \ relation� U 6u�6�nga w�� must be filed with this appxcmr/wmF <br /> Kq� | �o�og ���\� \m�a�nn ���mn �a onmwm�. . . <br /> FOR DEPARTMENT USE ONLY <br /> �T�-' ' � <br /> ----------------------------------------------- <br /> "�� ~ u \rrruCA/' ' ` <br /> REY|EVGD BY__----------------�—'— ~ ��---''_ ---------------------- ------------------------------------------------------------- <br /> BUILDING <br /> .� .—�------------' <br /> BU|LD|NG PERM|T ISSUED_---__-___''�__----_-'----''-_'''- _ ___ D/ TE_ <br /> ____._____..._________.__._____ <br /> ��tera�ons and/or repommen6mt�nv .--_---_--.---.._'_--__--..___. --.____.________._______.______.___. <br /> _..___----__-.-__--..___-..___._-___-__--_-_.___..-__-' .-___.-'__---___---------_-__. <br /> -___.'__-----'-__-'-'___-''___--_-'-_''''___'' --'--'-'---. <br /> .� ---- <br /> Date-----_---.--_-. <br /> SAN JOAQU\N LOCAL HEALTH DISTRICT <br /> l30South American Street <br /> ` Sfvck+on. CaUfornia <br /> p*-9-2w 9-50vw639 <br /> - - <br />