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3 60 <br /> Permit No. <br /> mplete in Duplicate) Date Issued <br /> to Issued <br /> This Permit Expires 1 Year From D <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND,�OCATION. <br /> Owner's Name.........11!��.. ------------------- ..................................................................jh Ll <br /> Installation will serve: Residence part ant H se [] Commercial [] Trailer Court [I Motel [] Other <br /> Number of living units: 2---. Number of bedrooms #--- Number of baths Lot size ------------ <br /> Water Supply: Public system P_�'Community system [I Private [] Depth to Water Table� ft. <br /> Character of soil to a depth of 3 feet: Sand [] Grove] [] Sandy Loam C1 Clay Loam [-] Clay Cl Adobe 0---Hardpan 0 <br /> Previous Application Made: (if yes,date-- -----------------I No LEK New Construction: Yes k]-1�o [-] FHA/VA: Yes J-1 No [I <br /> TYPE OF INSiALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> am founclat <br /> Dis laid: Distance from nearest-wel tance fr ion...../*-D. Distance to nearest lot ine.....�C_ <br /> Type of filter maTerial---Xj�i�l�epth of filter material--.- -----...-Total length <br /> Seepage Pit: Distance tvnearest well-_---_--_-Distance from foundation Distance tunearest lot line................. <br /> [] Number nfpits----------------------Lining m*t*rioL--------------------Size: Diameter. _-__----Depth-------.......-....------ <br /> : Dbhaocofrom uoorn� *�L-___-.0btunvo6vm6*wJuMon_-_-__-�L�inqmuto,�L_ list^ . ' <br /> Size: Diamotec----------------------------------- D4nth---------------------------------------------------Liquid Capacity-----------_-----'-ga|o. - <br /> Di�oocofrom nourn� well___'______-''-_r�dan»ofrom 000ra� 6ui@iug'_-- v <br /> Privy: Distance tonearest lot line--------- --------------------------------- -----------_-_--------------- ---------------------------------------------------- <br /> tit <br /> Remodeling and/or /opui,ing :--_-_-------.--_-����-� - <br /> ` �v <br /> �.__� <br /> '----_-_--~---------'---------�-------_--'__----~-_.-------_-.---_--__--_-_-'--__-__-___-_____'_- ^�� <br /> -----_--_---_-'---__'--_---_--.-_---`__..----^_-^-~----_-^--.'_----_------------_'__--.-_-__-___ ^ <br /> ------ -------------------------------------- ����������������������������������������������������� ----------------------- ---------------------------_ <br /> h �6t� application 6that th ,kiUbe6 in accordance with San Joaquin Cowxfy <br /> ordinances, Ste —ws and <br /> and regulations of the San Joaquin Local Health District. <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> Alterations and/or recommendations:------- --------/X_ <br /> '-- .�� � �+^ <br /> � -1 - <br /> --------------- <br /> ���-�--_��c-�-__�-�~_-c ��------_-----__----_----_----__--------_'--__---_----_- <br /> ----- ........- ...................-..................------------............................................. <br /> FINAL INSPECTION BY:...... Date------------ ............... - ......... <br /> /~^^ . <br /> /��NJOA�U|N LOCAL MEA�H DISTRICT <br /> 1601 E.o"m//w«v°. 3a*West Oak Street /2*/y'om",^Street zv5West 9th Street <br /> v/wkm",vo///v,"m Loa/'cv//f.,"i. cv/aw^/v rm*, C^//famm <br /> Es , REVISED *,v3wa63 ,pcn <br />