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FOR OFR[ USE: <br /> Application is hereby made to the San Joaquin Local HeaI+h District for a Permit to construif and install the work herein described. <br /> This application is made in compliance With County Ordinance No. 549. S-W. <br /> Installation will servo: Residence Apartment House Commercial 0 Trailer-c7n X Motel 0 Other 0' <br /> Number of living units: .-/.. Number of bedrooms -11.-Number of baths.../... Lot size .4 <br /> Water Supply: Public system 0 Community system 0 Private A Depth to Water Table &_ ft <br /> Character of soil to a depth of 3 feet <br /> Previous Applicaficin Made: (If yes,date-----.............. ) No E] New Construction: Yes No FHA/VA. Yes No r-1 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permiffed if public sower is available within 200 feet.) <br /> Septic Tank: Distance from nearest well- DistanSie f fo d <br /> Disposal Field: Distance from nearest weli.1-5D.-Distance from foundafion..-L--O-"-..-Distance to nearest lot line_%�Raf7 <br /> See Pit: Distance to nearest well..7-AIA'- <br /> Cesspool: Distance from nearest well ................Disfanc"____,- ____" --------- <br /> Remodeling and/or repairing (describej:......... <br /> ...................... ----------- ---------.... ................................................----'---'------` <br /> y hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances ws, and rules regularjons of the San Joaquin Local Health District. <br /> (Plot plan, showing size of lot. location of system in re"I'a,fion to wells itild-1,19 , etc., can be placed an reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> -- ............................................. ........ ....................—.................... ......---------................................................................................................ <br /> .................................................................... ....... ................................................................................................. .............................. .......... <br /> -...................... — ....... .......... .......... ......................................... .................................... ........................................ .... ............................ - <br /> .........._........................................... <br /> HNAL INSPECTION BY: ^��— <br /> __- .------------------- Date D*+m----.. --� '�m'.m--'--------_—_ <br /> SAN JOAQUIMLOCAL HEALTH DISTRICT ( f <br /> ' <br /> vawomwp=*lenAve. 300 West Oak Street 1u^Sycamore Street uwsWest 9th street <br /> Stockton,California Lod/ California Manteca,California Tracy,California <br /> Eupxm/ <br /> � '67 v�"�wardn°= ^x�~21�r7 � — <br /> �d�w'° ~ <br /> � <br />