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----�-r------~------�- <br /> \ <br /> -- FOR OFFICE UV: <br /> ^r----------I p4 ���� ��������m��� r��mnnn Permit- '- ---� , <br /> APPLICATION- ` [,~& <br />------------------ <br /> (Complete in D°*"=^'~v Dote issued <br /> ----------------- --- This Permit Expires I Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a p mit to construct and install the work herein described., <br /> This application is made in compliance with County Ordinance No 549. IX <br /> , <br /> Installation will serve: Residen I ce ET"-Apartment House El Comme-rcial E] Trailer Court C] Motel [3 Other 0 <br /> Number of living units: Number of bedrooms Number of baths J__ Lot size ----------------------- <br /> Water Supply: Public system [D Community system 0 Private ga-Depfh TO Wafer Table _. _ <br /> ~ <br />� <br /> Previous Application ,°=de^ v. yes,date---- ---- --------- No (B New __ <br />' TfPE OF INSTALLATION AND : <br /> (No septic tank or cesspool permitted R publicsewer is available within 200 i <br /> 'Septic Tank: Distance from <br /> nearest wn __5t2-'--"'"`""^e �o found Mon'/P_- ku+o u I~- <br /> ""/' No. of ovmpor�n�nt,-'�~-_--.S|zo-���4 '�.--_-Uqu|6 6eo+ -- r-,----..Ca'p'uc�-y.=' ' <br /> D;soosu F��: Distance from '---------Distance from founclaflon19..............Distance to nearest �t |�m' <br /> of | � � ocn /m�`?�q�� Width of ^~ <br /> nT �. <br /> Number <br /> �-~�- <br /> - <br /> k � <br /> 'p � � �n ° - �� to .__ . U ~ <br /> Sempuga Pit: Distance to w4fAP---- D�anc 6n �mn6ot ` ' �-. <br /> �c �---Sbu: Diameter.. -.--Dnp!h../pZ*'-/------1 <br /> ._--- <br /> � <br /> ° - <br /> � � <br /> Number �f p� -.y-.__-L|ning mute�~f�� <br /> Cesspool: Distance from nearest well foundation-__ m�to�mL----_-_-_-' <br /> - ���� D|�mn+n, --'-''-'-'-''-Dnot6 ' Uqui6 ~~r~ , -_--g�� <br /> .-Distance {n,m nnur�v building ' <br /> y�'y` Distance from neuna� ,mU--..^------_----' . ----'_-__-_-. ,~�� <br /> ElDbtunco +unoa,e� �f |�o''�'-''-'''-_-''---__.^-----_._-------'_---''----''--'-'-' �� <br />` <br /> Remodeling and/or repairing (describe):--------- -------------------------------------------------------------------------------------'--_---''--__--____- <br /> ___..__---___.--..-_'-----'—''--'----'---''----''-----''---'''---'--'----'----'--'-- \ <br /> ___________.____.__.___._____________._______..___--__-_------------'--------- \ <br /> ___-_.'__-''--__-_.---_------__._.__-._-_-'__..__.-''-'_--''-_-- <br /> I hereby certify that I hav'i-prepared this application' '--'-'-------''--'-� and that the work will be done in accordance with San Joaquin County <br /> � -mr6�ance� S+a+o laws, and rules and rwguannnn of . <br /> / <br /> ' ' | <br /> � - (Signed)-- <br /> `------------- <br /> (Plot plan, showing size of lot, location oi sy----------in relation f wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> -------- ---- ------ <br /> ------------------------------------ <br /> ----------- y................................. <br /> BUILDING PERMIT ISSUED------------- --- DATE <br /> Alterations and/or recommendation s ------------ <br /> ---------------------------- <br /> ----------------- ----------------- ------------------------------'---'-----'---------'------' <br /> --------------------- ---------------------------------- '''' ' <br /> --'''''-''--''--'---'-'-''--'--'- --------------- <br /> --------------------------- <br /> RN�L (NSP ' u -.--------.- <br /> SAN JOAQU\N LOCAL ���kOH D0T��o �^ <br /> ' 1owSouth xrn°,/*""Street xowWest Oak Street 12*Sycamore Street xusWest 9th Street <br /> m""kio"'c"nfo,"w Lodi,California wm"w=.Cmnforn/" Tracy,California <br /> cv nREVISED o',rzm5'auATLAS <br />