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- - <br /> . --- <br /> |{�y�T|CJN FOR S/\N|T/�T|{��� PER ` Permit No -'~������� <br /> ��mp�� � ��k��> <br /> ' ' - Date Issued J'��<'��-'����^ <br /> Application i, hereby made to the San Joaquin Local Health Dstrict for u permit to construct and install the work herein Jo,c,i6o6. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB xuuxESu xS' <br /> 1� ll �V m 4 _-11YE--'--' <br /> Contractor's /^Contractor's Nomez�Ld-------- -- -'------ Phone.---- <br /> Installation will serve: Residence [] Apartment House Ej Commercial Trailer Court Ej Motel L] Other L] <br /> Number ofliving units: .._~-Num6*rofbedrooms -------- Number of baths .-~' Lot size .-x- 7"�_._-_-_-- <br /> Wate, Supply: Public system Community system [�] Private F] Depth to Vater Table 34� ft. VC11— <br /> C6amctv, cf a,i| to u depth of feet: Sand [] Gn,vo| E] Sandy Loam [] Clay Loam [] Clay [] A6o6o �Y Hardpan �] <br /> Previous Application Made: Yes E] No Now Construction: Y�, �] No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer isavailable within 200 feet.) <br /> k Distance from noun,s+ well---- ----------Distance from foundation-------------------Material -------_-_--_-'_.- <br /> Nm. of compartments------ ------- -----------Size--------------------------------Liquid Jvp+k - - -------------Capacity_--___--' <br /> Distance from noon,s� wo| ��{8��- foundation <br /> --,_- � '_-_-. ._.. ' v <br /> D� <br /> Number ofLengthofeach <br /> Type of filter mofo�o| 'Dc�� of filter mof�,iuL�~/u�...-.-Jot | |eng+k-..-,�/7^---____- <br /> Seepage Rt Distance to nearest ~ai ./YL /x ----Distance from foundation--- ' lot line--.:?/-, <br /> El Distance to nearest lot line--.--.--,------- <br /> Remodeling and/or repairing (describ <br /> ------------------ <br /> I hereby certify that I have prepared.-this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, S+ft!�,Iaws, and rules and re'I gulations of the San Joaquin Local Health District. <br /> (Plot plan, showing size of lot, location of system ii� relation to wells, buildings, efc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> -------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ' ---------------------------------------------------------------------------------------------------------------' <br /> ----------------------------------------------- <br /> --------------- --------------------------------- -----------------------------------------------------------------------------------------------'—' <br /> FIN/\L INSPECTION BY ~~-`°' Date--- ^c .__�--- -__-__- <br /> I4NJOAOU|NLOCAL HEALTH DISTRICT <br /> /m South *=°,ic"" Street :ooWest Oak Street /o Sycamore Street o/* North ''o^ Street <br /> s,°"k+"". o"m","/° Lodi, California w""+°"". o":f","i" Tracy. California <br /> ES-9-2M a's/ x°./sea w'z/on <br />