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����� ��j���k����� ������� Ponn <br /> �w~ | ' - ' ---' ''—' ' ' No. <br /> » ' � Omu�m�\ Date |,oueJ <br /> (Complete— ''--- r <br /> Applica41on is hereby made to <br /> e San Joaquin Local Health Dstrict for o pa"nif to construct and install the work Herein described. <br /> This application is made in compliance with County Ordinance No. 549 <br /> 1,110 <br /> Apartment House E] Commercial [ <br /> Installation will serve: Residence tTrailer Court E] Motel E] Other E] <br /> Number of living units: Number of bedrooms Number of baths Lot size -------------------- <br /> Water Supply: Public system ��Community system E] .-Priva-te Ej Depth to Water Table ft. <br /> Character of soil to a depth of 3 feet:1 S d Gravel E] Sandy obe a-___HardPan El <br /> L am Clay Loam Ej Clay E] Ad <br /> Previous Application Made: Yes E] No ��New Construction. Yes'o;"PN- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within6'200-feef.) <br /> 4eplic janl: Distance from nearest well----------------Distance from foundation--------------------Material-------------------------------------------------__.- <br /> Distaiice fra�i nearest well--7 <br /> ,710------40istance fromifoundafion----- Distance to nearest lot lin'e----------------- <br /> P" e Yil, Distance to neartst well----------------------Distance from foundation--------I------------Distance to nearest lot line <br /> e:F-K <br /> ' ~~^^'~~'' " ~~'~^^~ '��'��~~X~^' ~~^ll------'�'^'�"`� """' '"""""''""�--���������-�"""* "'"=`�'----------------- <br /> [] S:zv: Djamefec.—..+---------------- ---'Doof ----------------------------------------------------Liquid Capacity----------------------------gals, ^ <br /> Privy Distance frorn nearcist wu|L''��- --------_�---_�� ------- from nearest building�_'-_-'-__-'-''_' <br /> [] Distance to nearest |u+ line -----------------------------------------------------------_--_--___��__-.---._----_-� <br /> K- <br /> . . � <br /> RemmJ | 6/o ---------- -------------------------------------------------_____ ----------------- ___________._________ <br /> I hereby certify that I have! prepared fhis application and that +he work will be dbne in accordance with San Joaquin County <br /> ordinances, State laws, and rules Ad regulafions of the San Joaquin Local Health DiOricf. <br /> JPIot plan, showing size o o , ocation of slem in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---------------------------_- ------_.. .1� DATE-- <br /> ` <br /> REVIEWED DY'''-_---'__'--''-''-'''_-�- --'''-' 1/*�� [� _-__-- D�TE-.�-J�'�����''` __ <br /> BUILDING PERMIT ISSUED---------------------------------------------- ----------------------------- ----------------------- DATE------____----______ <br /> A�o,m�onsand/or ,ecommwn6e�*ns:----------.--------.----.-_--------------._--_.____.____.____. <br /> .—_-_---_-___.__.-----_----._--.—_-_--.__---_-_---'_-_--_--_-_.._____.--'_-- <br /> __________�_______'___-________________________________________'______________'________________' <br /> '------'----------------------'---'-'----------'----------'---'-------' <br /> -�'��''���'�'''�''��'''''��.���''�''''�'''-�- �'���'��''''�''���''��'''���'��'''��''����''�� <br /> V*�4 ~~ -7�N/\L /NSPECT|�]N BY�---------- - Do+e----. �/`--.-�----L---.-_----.-. <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> /no South American Street yvoWest O^l Street oz Sycamore 8+re°+ ow N**h "C" Street <br /> e"tlifo". California Lodi, California ^xa"wmo. California Tracy, California <br /> ss--v-xw n°./°°J vv-2/00 <br />