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- <br />APPLICATION FOR �� �-PERMIT Permit No. --6 <br />` <br />(Complete in �� <br />Duplicate) |omo6--'' <br />_--Date.' <br />gplic6-ion is �w made � San <br />Joaquin Local Health District for a'permit to construct and work herein described. <br />/nmapplication is made in compliance with County Ordinance No 549 ' <br />JOB ADDRESS AND LOC <br />7 -------------- -- - -------------- --------------- <br />O"wnars Name --z- <br />-------------------- <br />Address-- ,L��4 L�-) - ----------------- Phone;4,1 ------ <br />.._..._-________________... . ^+ <br />. . <br />-------------- <br />Contractor's Name <br />----------- <br />4�r�r�°�..-----_-------._._--_--. <br />------------- <br />Installation will serve, Residence m/^partmenf House [j Commercial E] Trailer Court E] Motel Other F1 <br />Number ofliving units: -j---- Number -of bedrooms --- /. Number of baths -/- Lot vizo-,-...... ------------------- <br />Water <br />__'__Waten Supply.- Public system Ea~~CommunKY system [] Private E] Depth to Wafer Table -------- ft <br />Character of soil to a 6epth` of 3 fee+: Sand E] Gravel 0 Sandy L� Clay Loom'[] C�Adobe o�n �] � <br />�ov�v ApplicationMade: Yes E] No 2" Now Construction- Yo, ;No [� <br />TYPE C]FINSTALLATION AND SPECIFICATIONS: <br />(Nn septic tank or cesspool permitted if public sewer is available ��|n 200 feet.)( <br />' . ~~~~, *�, <br />So nk' Distance from neo,oxf woU t Di '� <br />- ' ~ ---'--'- ~"�"= ----' �~� q7 - <br />No� oJcompo�m�nt�--��`_-��_St"ui� 6,pfk-.��^=-_-'Capod+y_ __-Disposal �w <br />Field: Distance from nourvo well -'�'----- Distance from foundation ------------------- Distance tnnearest lot line --------------- J <br />E] Number of lines ----------------------------------- Length of each line `-'''-'-''-__Width of trench ----------------------------------- <br />Type <br />'_-'''_________Tvoe uffUto, mm+e�oL'-'''---'-Depth of filter material --'''----- :-Total <br />length -------------------------- __-- <br />SnepoqPit: Distance to nearest well —--,--.--. to '-~'~+|~' | 477 <br />----- <br />Number of pits -...+--- Lining mute,iaLuY'an2U.Sizn' <br />u`om�+�c..��°��---Depth��=�.��.---.--'-.' ^ � <br />Cuopoo|. Distance from nearest well ------------------ D�st nu,from foundation --- --------------- Lining material -------.__---_.- <br />[] Size: Diameter --------------------------------------- Depth ------------------------------ --------------------- Liquid ---------------------------- <br />Privy, Disf nc= from neonaof well -- ---------------------- ------------- Distance from nearest <br />_-.---__--_��-u_-36in-_g'------------------------------------------ <br />Distance to nearest <br />-__--__----_Dist nce+onuunast lot line `''--'--''-'''- <br />Remvdv' . �� '_ <br />'---_'- '--'---'x- ^-------''--'---------''---'-------'-------''-_-''__'-_-'___'---'-----.''-'--.--'---'---�---~~-''--------------- <br />------------------- <br />_'''''-----_-'-''-'''-----___.---_-._-_-__-.__---_'^--_._-_-_-__--__-,_-----. <br />]l <br />� <br />hereby - certify -that I have -prepared this application -and that ^~~~^~^'~`~~^""'"^~"="==w"",="nJoaquin County ' <br />State laws,tand rules and regulations of the San Joaquin Local Health District. <br />^ � <br />' . <br />(Signed) �------- --�'--'�'--'''---`''--'-- C°"'=°'"v <br />By:_ __________________________________. _________ ~~ � <br />--- <br />(Plot plan, showing size of lot location of system in relation to wells.. 6ui|6in�o. etc., can placed on reverie side)./ <br />' <br />� <br />AFOR DEPARTMENT USE ONLY <br />PPLICATION ACCEPTED 8Y ------------- ---------------------------------- . DATE'--- <br />REVIEWED BY ---------------------------------------------- <br />----_------------ ------------------------------- .- DATE-_-.-cr._ <br />BUILDING PERMIT ISSUED --------- DATE ------------------------------ -___-�---'_ <br />AHe,ufion» and/or recommendations: ----------------------------- <br />------ <br />... <br />_-'------'----''-'''-''--''''_'''-'''_-'---_-----'___''__---''''--',_.'-''-_''--__-'_____.'-- <br />-.__------__-------._--_-.___-----_--_-.__----'_--.-_---__----____---- <br />-_-'-_'-'''_'--_'_'-''''.'-'''-''''-'''_'''_'--'-'-'''--''-----'-''-''''-'----_--'-------'- <br />.--'-^ ''-'------'-''--'_-.-'�' <br />---'''-''''--'-''''---''-'''-''''-'--^''-'-~~-~----------------------------------- <br />��-�--'--''-''--'----_'_--' <br />Ov7 -5_1VFINAL INSPECTION BY: -��� ------------------------- Da+a'-'. 57 --------------------------- <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />-------------------------SANJOAQUINLOCALHGALTHOISTRICT ' <br />U. <br />/sp s"um *m^a=" $,wm 300 West Oak Street /xc sv"°m"re str^*+ m* w°+h "C" Street <br />Stockton, California Lodi, California Manteca. California Tracy. California <br />ES -9-2w nowwd vv -2/00 <br />_ <br />