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FOR OFFICE USE: <br /> .............. ' . <br /> ' -_-_' -- . <br /> _ ...... �w (Complete in Duplicate) Date Issued <br /> | <br /> ��_ �. � <br /> ............ ...... This Permit Expires 1 Year From Date Issued <br /> _ <br /> Application <br /> This application is '-_- - _-m`-__~ with County Ordinance No. ^`,, / o3 <br /> J7 _ <br /> JOB ADDRESS AND uOCA/ <br /> Cont IV <br /> Installation will serve: Residencejo Apartment House Commercial [] Trailer Court [:I Motel 0 Other I-] <br /> Number of living units: _� Number ntbedrooms _2­ Number of baths -L. Lot size -- ,�-_--_- <br /> Water Supply: Public system [] In <br /> Character of soil to a depth of 3 feet: Sand Gravel I-] Sandy Loam [] Clay Loam K Clay 0 Adobe C] Hardpan 0 <br /> ' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No sepfichank or cesspoolp�rmlffed if public sewer is available within 200 feet.) ^ <br /> / i ' <br /> Septic Tank: Distance from nearest me;L------.Distancw from fomndution.-.............Material --...................... ................... <br /> [] No ofcvmpartrn6enfs- Size' Liquid 6ep�h C ! <br /> � <br /> Disposal F�� 6n � x^ <br /> nearest well--/ -.Distance from LDistance to - � <br /> Number ~. ..~= <br /> ° � . -��� -_filter -__-- <br /> Seepage Pi �� <br /> ` �w\ ��---'- ista nce to --rest- -' ----' - <br /> I 1k <br /> Distance to ne�rles ' <br /> _ _ --` -- --- �Romo6e�g and/or - -, ` - _-- i_zp ~ =-------' ~- ^h <br /> � <br /> ............................................................................................................................ .................................................................. ...................... � <br /> .................................................................. ......_-........................................... .............................................................................................. . .~ <br /> . '---.......... __-_--................... .................:................. <br /> hereby certify that I have pre-pared this application and +hat the work will be done in a�corclance with San Joaquin County <br /> ` ,- <br /> `~ ' . <br /> . / <br /> (Signed)- �......-_- �yner � <br /> / <br /> ! <br /> (Plot plan, showing � ~ =` �� = �= = �� � we� ��n� m� � � ��d � �� �� � <br /> ' .~. DEPARTMENT- USE ONLY <br /> � <br /> APPLICATION ACCEPTED BL---._��'^��'---_-_-_--_----__-_---_-' D/�E-- ���-_-''-'-.- <br /> RBNEVVBJ8Y.............................................................................................................-............. DATE......... .............................................. <br /> | BU|LD|NG PERMIT ISSUED.............................................-............._...................................... DATE............................................................. <br /> � <br /> Alterations <br /> ��v �«� <br /> FINAL INSPECTION 8Y:---'��'=,���--�---__--- Du+a.-^~��'~����� -'--'----�_-' <br /> � ' <br /> ./ SAWJOAQU|N LOCAL HEALTH DISTRICT � <br /> 1am, aHas.»=Ave. / mmWest Oak Street 12*sy4"m"re Street 205West 9th Street <br /> vto,mo" California Lodi,California wv"uco'C"ofomic `=ly.c"/a"rnia � <br /> "'°=0. <br /> � <br />