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f <br /> FOR OFFICE USE: <br /> APPLICATION F611 SANITATION PEP-MIT Permit No. ....... <br /> Date Issued A-3 <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descrIted. <br /> This appiication is made in compliantceitth -County Ordinance No. 549. <br /> �`�" ``"""=�� ~""° o <br /> m -`- = .- -�_" -" ----..�[ <br /> ------�Cnn�ucto/o Name---------------------------------------- _ ._.--_--._-' - phnn�-----___------' <br /> '~' Court �� - Other <br /> m�mnanonwmnmn � nnxmw np� e"` " Commercial [I Tr� <br /> Number ofli�ng units: -1_ Number ofbedrooms _ umber ofba+hs - Lot v�o �Y'^ <br /> _ '---' <br /> ' <br /> . <br /> Water Supply: Public systemsystem [] CommunityCommunitysystem 1-1 �� To Water Table -_ ' <br /> Character of soil to a depth of 3 feet: Sand [] Gravel E] Sandy Loam E] Clay Loam E] Clay Adoba[] Hardpan C] . <br /> Previous Application k4wde: (if yes,date--------------------) New Construction; Yn^�� No FHA/VA. Yes E] N 0 <br /> ' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (Nm oamfic tank or cesspool pmr,�it+m6 if public sewer is mvm\|mb|m within 200 feet.) � <br /> Distance from nearest well;---, ......V.; <br /> PR No. of compartments- --- _X_10 Xbq u ------- -----:!ill_/- ---t <br /> S ivea id depth <br /> Disposal Field- Distance from near�eft Distance from founclation--AR 6 Di t t st lot line.._r..... <br /> ---------------------- <br /> Type of filter mate I rial.3�7__Z�_ epth of filter mate' <br /> Seepage Pfff: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line------------_ <br /> , -- -------------------------------------------------- --------------------------- -------------------------------------------------------- . <br /> ------..........--------------------------------- --------------------------------------------------------------------------------------------------------- ------------------------------------ <br /> ---. � <br /> ----------L_..__-._-__-'_.___�-.__-._--_-'--.___--___'-__.-_.___'._------------------- <br /> L _| <br /> herel;� certify that I have prepked this application and that the work will be done in accordance with San Joaquin County \ <br /> ordinances, State laws, and rule <br /> ,k and regulations of the San Joaquin Local Health District. <br /> ,^~' r~^' ~~~'`" '~~ of lot- ---'ion— of -'-- - --ion- to wells, buildings,— ek., placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED 8Y---------------------------------------''--------_---__.-_.--_.'-_' DATE--'--''--'--'-'-'--'-'- <br /> RGV|EVVED ' DATE / <br /> �U|U}|N(� PEK��|T |33UED-'--_.--_.--_-- .. D�T��--_^,�_^�*^�r�^� ��----------------- <br /> ---------------- <br /> Alterations <br /> ,--_-- � <br /> Altm,mMmnwmn6/nr rew*mmmen6ation$:--------------------------------------------------- -------------------------------------.-------------------------------------------------------------------- <br /> '----'---------'---------------------------'---'--'---'--'----------- <br /> ------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------- <br /> / <br /> '------------------------- ------- ------------------------------------'�-''--''-''-_--' '-''''-''-'''---'--'-'-''-_''--'-'-'''- , <br /> / <br /> .----'-'-'''--'--- -- '-'''--''- --------------------- '''-�-' --------------------------------- <br /> / <br /> ! ' <br /> +7 -�� �� <br /> � ~�°-- � `�� <br /> FINAL INSPECTION �8Y:--.. x��wm���--' Date------��----'---------------- <br /> SAN JOAQ0N LOCAL HEALTH DISTRICT <br /> 130 South American Street 0 124 Sycamore Street 2wx'West 91mStreet <br /> Stockton,California ' m""to=.c"//*"=ia Tracy,California <br /> cnnREVISED n'n9zwy'acATLAS <br />