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' <br /> . <br /> . � <br />�« � APPLICATION FOR ���� PERMIT Permit No*n� _+. <br /> � C�u�a�\ <br /> (Complete- - ---' �-��+~ Issued _u��.xuw'�.�~� <br /> � <br /> made foho Son Joaquin Local Health Districtfor permitfoconstruct and install� thwork bore described. <br /> Ic <br /> This application is made in compliance with County 01rd' ce No. -149 <br /> JOB ADDRESS LYATIONt------------ A <br /> Owner's N <br /> Installation will serve: Residence Z Apartment House El Commercial El Trailer Court E] Pofe� L] 0 <br /> ths <br /> Number of living units: ---L Number of bedrooms __jZ_ Number �ba J--- Lot size ---- <br /> WaferSupply: PublicsysternEl Community sysfemCl Private VDepfh to Wafer Table .------- ft. <br /> Character of soil to a depth of.3 feet: S Gravel E] Sandy Loam Clay Loam E] Clay E] Adobe Er/Hardpan Lj <br /> Previous Application Made. Ye.�s E] No ��New Construction: Yes ;XNo <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sevier is available within 200 feefl� <br /> k: D�stance from nearest well----/ <br /> P �_ e------r e - ---------41 <br /> Dis Field: Distance from nearest welL. 0---.Distance from foundation----0T___t__Disfance fo nearest lo Ii <br /> -- � of each Iine---..~ ~_ ' . of trench <br /> Type of fi|fe, mate,; L— <br /> v¢����� �+ of filter mu+�,o . ----Total <br /> Seepage PitDist U ancenearesine ' <br /> gals. <br /> - � <br /> riv <br /> ' - _- _._����—'''-''--.'''�-~~...^� '_-'--�----- . <br /> Dbtnrae to:nearest lot |ioe.,_-_-_--._-.--.-___--__ -._._-_ ____----_-_---. � <br /> - <br /> Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------------------- <br /> -----------____-_--------.___.--_--_._-.__-___^___--_---_---__-._.---_---___-__---__- C. <br /> --"-'--'__�''___.''--'--'..�--__--_-__'._'_._._-_-� <br /> __'_--__--.�-_--.--^-_---_-_-----__ <br /> _____-_-'----_--~-x__~-- <br /> -_.—.__---_'�---_.. -_.-_-_.__--__-.__.-.__--__---_--_--_----_ -------__��.�--� <br /> _---_---'-' <br /> � <br /> � <br /> J| one <br /> ance with <br /> San <br /> hereby �urmmuJoaquin <br /> �------------------------ <br /> ------- <br /> FORDEPAR?MENTUSEONLY <br /> ~ "CA''` . ACCEPTEu BY ' �-- '-KBEWED BY___ --'_''---�____________�____________ <br /> 8U|LD|NG PERMIT ISSUED------ 5� ' <br /> .. ---------------------------------------------------------------------------------------� D�T - .. <br /> Alterations and/or ,evpmmon6a+�ns:------_--- ��_.-''--'__ ____._ <br /> '_---'--_---'-_.'''_-'''_-'�-'---'''-''''--''''_--''__.''''----_'-''-__-'''_-__---_.'__. _- --. <br /> ������'�����������'����--����������������_�-�����'������'��'�'����� � <br /> _---_------'�''''_-''-''''-'-'''''-''''-_--''--'''---'�--'—''---''''�'-,''''-_---' '-_--_' '- '' <br /> _'-__-'__-''-'''�-�''�'_-''''--�''---'-----'_- -'---'''''-''����--'-'_--''''�'- ''--'-'__. _- <br /> �N \L INSPECTION --' ---�-'' __ - �-----_-__'-__ Date--.- <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West O* Street /rx Sycamore $=° 814 North "C" Street <br /> Stockton, California Lodi, California w""m=*. o"x;","m n=vv. California <br /> Es-'9-2w 8-5/ mava,d W'2/vo <br />