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~ <br /> FOR OFFICE USE: <br /> ...........I.......... .................... (Complete in Duplicate) Date Issued._.7/1X0A�­­y <br /> - ----- ... ... This Permit Ex�ires 1 Year From Date Issued <br /> for a permit to construct and install the work herein described. <br /> Application is hereby made to the San Joaquin Local Heal+h District <br /> This application is made in complian�e with County Ordina-nce,No. 549. 0(3- L&V—S 0 <br /> 0_C:;kTibN _4 ---- ......... <br /> JOB ADDRESS AND L A <br /> installation will serve: Residence 0 Apartment House [I Commercial Trailer Court 0 Motel 0 Other Rlq_� 10- <br /> �Iater Supply: Public system El Community system 0 Private Do h Water Table _"­_ ft. <br /> Character of soil to a depth of 3 fee+: Sand [] Gravel 0 Sandy Loam;rClay Loam[I Clay 0 *Adobe 0 Hardpan 0 <br /> No New Construction: Yes E] No [I FHA/VA: Yes [I No C1 <br /> Previ �us Apprwation Made: (if yes,date -- - ------:- - <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 97'r, <br /> (No septic +ank-or cesspool permitted if public sewer is availa6lo within 200 feet.1' <br /> Se ank- Distance from nearest well_*_Q�)-------Distance Tp m <br /> pe -----------------Size4i/X, --v?7 4� 401 1k <br /> nce to nearest lot line.,g <br /> Disposa ield: Distance from nearest well___940.'.:.Distance from founclation.,A0.......L.Dista <br /> Seepage Pit: Distance to nearest wall......................Distance from founc1ation--_-,.--_._Distance to nea <br /> cesspool: Distance.from nearest well-.------------�Distance from foundation ...................Lining maferi ------- <br /> Privy: Distance from no <br /> Cl <br /> I hereby certify that I have pr4atiod this application and that the work will be dome in accordance with.San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Plot plan, showing size of lot. location of system in relat on + oils, buildings. *+c, can 6e.placed on reverse.sidel. !E <br /> _ 0 <br /> FOR DEPARTMENT USE ONLY 0 <br /> Alterafions and/or QW <br /> r*commendations__................................................................................................................................................i <br /> 77, <br /> _____.__-_'—__--.--_�__—_—_..______'—_--.___.—_—___.—___._____-.__.-_--___-.__—__- ' <br /> ~~ . --- <br /> SAN JOAQ . LOCAL HEALTH DISTRICT <br /> 1601 <br /> - _- <br /> 1am1 E.o=°wnAve. anoWest Oak Street `2*Sycamore Street owsWest 9th Street <br /> St"kion'Caofornia Lo-di,Cafifornia Manteca,Co/ifontia nracy,eifamia <br /> m" ° REVISED °-S* »° 2-'6ar.P.uD. 57 1 ` )/J4 ' <br />