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APPLICATION ��� �����T �� ;���� ��� �� _11-0--- <br /> (Complete <br /> L[� <br /> ^ - __-- <br /> k���p�te0m <br /> . ' ` Duplicate) Date Issued <br /> . . � <br /> gplicafion is hereby <br /> � <br /> de to the 'San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> 's application is made in compliance Y�ifh jCounty Ordinance No. 549, <br /> TION <br /> PTION ":2 <br /> JOB ADDRESS AND LOO _9? ------------ - <br /> Owner's Name <br />. _ __ _ Name_ °______°~~ Phone_ <br /> .n,n^/lanon will serve: Residence J�r"Aparfment House LJ Commercial [] Trailer Zc5u-rfZD Motel L] Other 11 <br /> Number of living units- -'/---- Number of bedrooms-Y-- Number of baths J---- Lot s`ii,6,_�40_ <br /> Wafer Supply; Public system E];, Community system Vj"'Private F-1 Depth to WaterTab�. <br /> Character of -' to - depth- of 3'f-et:et: --�w ~~`~ E] ~~'~' L~~^' 0 Clay Loam E] ``'ayE] Adobe 8' Hardpan El | <br /> Previous Application Made: Yes E] No ET"* New Construction: Yes � � ` . �» ��No � <br /> -- � ` \ - <br /> - <br /> TYPGOf |NSTALLATON AND SPECIFICATIONS: <br /> (No septic tank or'cesspool permitted if.public sewer is'avai'lable within 200 <br /> l <br /> Septic Tank: Distance~ from ^~~'~~'l~~1�' <br /> Disposal Field: Distance from nearest-W-'e'll......—------Distance from fcunda6pp-----a------- -Distan'ce to nearest lot line---110-------- <br /> Type of filter material-/ __Z-----------Total le' __4p <br /> Seepage Pit: Distance to nearest well'--- -—---------Distance fr afion----,? <br /> �] ���� [��mo+�c _°.'- ^ ����/� �,� # -`^-- Lining ^ '---'-'---- ! <br /> '`��'-,'--'_--,-''' ''--''-'��-''' ` J <br /> Privy: D;sf nce from nearest well ''-''-_ '�_-'-_--'Distance from ^ a ��' |d|- �-----------------__-.-_.--- <br /> [] D�tuncofvnearest lot line--- --,~.'_~,.._.-..| - ' <br /> Remodeling and/or repairing (descri <br /> �-'__-____-.. -. � ''__'-_-_-----_-._.�-_----__--_----.__-.. <br /> -'-'-'---'--''----'''-'- ___-__.'__'-__'-_--_-�'''---_-,'_--''-'--'-'---' <br /> , <br /> --'---_.--'__-`---_-._-.__.__-___.-..__-_-_-_'-_-._-__---_--._'-_-_�.'-'-''-'��-�-- <br /> | hereby certify that I h 'repared this application and that the work will be done in a 'cordance with San Joaquin County <br /> ordinances, <br /> State laws. and ' <br /> (Signed) A4 ------------�---. �..1._-�. , Contractor) � <br /> By:------------------------------------------- <br /> � '---_-----.-_]T��) .---- _--__-_.- - <br /> ��t plan, »�o of �t re�f�n'tw�/mU�-bwUd n� reverse- - ' side). <br /> FOR DEPARTMENT USE ONLY <br /> � --'--'-'---'----'----------..���..-..�[JF�0-.------_____________.____.___..________.__________ <br /> _-_ .__-_-'-_-----__--._-.__-_--_- <br /> ` - <br /> ����-------____------_-----_____���--__---__---__---_-----_-----_ <br /> � F-4. <br /> RN/\b~4 Dof*____ m�---- 'Y_______________ <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> /so y".m Am°a"°" Street 300 West Oak Street 132,Sycarnore Street uw worth ''o^ e=;f <br /> Stockton, California Lodi, California \wu6t�"*. Cw(|f*,k|^� { ~ Tracy, California <br /> `~ <br /> sS -9-2w . n=i"°" 1'57 Fnco. r <br />