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- . <br /> � <br /> APPLICATION A�� �����[N�� ������ <br /> . r yu | <br /> ^ �n OmoUoat� � <br /> � <br /> (Complete Duplicate) _ ���� | <br /> � /, � <br /> forApplication is hereby made to the San Joaquin Local Health District 6 Utheworkherein 6w�d�u6 <br /> ` s application-is made in compliance with County Ordinance No. 549. ' <br /> . <br /> JOB /\DORBS8 /\ND L{]CAT|{�N. .. .'����/�I..������_�---' <br /> -- ----------------------------------------------------------- Phone------------------------------------ <br /> Address-----------------^.--'_-_----~-^-------------------------- ---~..--._--------_-.-~---_-------_.----.-----_.. <br /> Contractor's Name----------------------------------------------------------------------------------------------------------------------------------------------- Phone----------------------------------- <br /> Installation will serve: 6 <br /> serve: Res� (euce' A�afrtmenf House []~ Commercial El Trailer Court-E] MotelEl -�[*6e, �[] <br /> Number of living units: ` Number of bedrooms [N Number of baths Qq Lot size-----------S/� �^_'_---- <br /> Water Supply: Public system E] Community system E] Private [&w <br /> Character of soil to m depth of 3 feet: Sand E] Gravel E] Sandy Loam El Clay Loam E] C|ayE] Adobe 0 Hardpan 0 <br /> TYPE Of INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> ~.^�. ~....~.~.'----.�-_��-'_-�---~~�..-_---_-------------- <br /> Privy: Distance fnom'n'e"°n:sfwell -------------------------------------------------Distance from nearest building----------------------------_.'------- <br /> Distance-.[� :6.'n6ura,+'|u+ line,..__--__-__--__.._ _ <br /> ; atjepage Pit: Distance to nearest we|L,_-__Distance from foundation--------------------Distance to nearest lot line------------------ <br /> Number of pits <br /> '-___Num6erofpds----------------------Lining material__. Size; Diame+oc____. _-_Duoth-__...,;Z,��=���- <br /> F��' ' <br /> � "s=~" "`"..-.="."^. . " ..".°�" Distance to nearest ~. ..._ <br /> / �� ' Num6v, of |ines. ------------------Length of each |[na. Width offrench''2_79E:F]rV_Z1_.--. <br /> � Type offilter �aterial_l-------------------------Depth of filter moferiaL'-'-'-'- , /~ <br /> k ' <br /> Rumodeling a=6/or repairing (describe):--_.-._-__�.--_._-__--___'-_.'___-__._--- ''-' <br /> . ' <br /> '��`''������'�������'���------''------'-----------------------'--------`��------'--`����-------''---------------------------'-------------------------' <br /> -------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------'----- <br /> ' <br /> � __-'-----'__.-_-_--'-'__'_--__----'_--__.---_.-'--'-__--_-'--.'�_---__''''__.-_.'_--__.'--'-- <br /> I hereby certify. at | have pr6pared this application and that the work will be done in a'Ccordwnce with San Joaquin County � <br /> ordinances, State kaws, and rules and' regulations of the San Joaquin Local Health District. <br /> � <br /> � � <br /> , �gnmJi-----_---_.-----------.-------'���---..�--------_----_--.--__--_--_--_.(Owne, un6/o, Coof,ucfmr)-. <br /> [ � <br /> ! ----------------------------------------------------------------------------------------------------------------(".=�__--.__---___-_--------_--'-' . <br /> (Plot plans, showing size of lot, location of system in relation to wells, buildings. *tc., must be filed with this a <br /> ^ <br /> FOR DEPARTMENT USE ONLY <br /> ^ ~E,.",,ED ". _=--- ----------------------- ~. -_ <br /> ^ <br /> ' �c --''----''---''--'----''--'' <br /> -__-__ ..__-___.__-__-____-_-_-__---__--___-. <br /> } ' <br /> PERM[TN ISSUED_��-L���.-_-.'-- Dufo 'FINAL INSPECTION 8Y� - ------ <br /> ---------------------- <br /> Date <br /> - <br /> [ Dot,-__.__�.[-----.—__..-_-'_.� <br /> j -- SANJOAQU|N LOCAL HEALTH DISTRICT <br /> ' <br /> |30South American Street ' <br /> Stockton, California <br /> � sS-9-2w9-mW�/639 <br />