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rh <br /> (Complete in Duplicate) Date Issued <br /> A�plication is hereby made to the San Joaquin Local Health District for a permit t�oconstt�ructt a do install the work herein described. <br /> T is application is made in' 'compliance with ounty Ordinance No. 549 <br /> Installation will serve: Res!I idence 291�Apartment House El Commercial E] Trailer Court E] Motel E]. Other 0 <br /> Number of living units: I---- Number of bedrooms J_ Number of baths /--- Lot size --------------------------- <br /> Water . . ' system El Community system 2"�rivate [_1 Depth to Water Table j4A_ ft., <br /> Characterof —' to - depth <br /> Previous Application Madel Yes E] No P"O'New Construction: Yes Rj--No E]- PHA/VA: Yes P----No El <br /> - <br /> TYPE OF INSTALLATION:' <br /> (No septick � <br /> iesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-------—------Distance from founclafion-ZlP-----------Material-----(-:-�__ & ----- <br /> ^ 0�' m <br /> Disposal Reld: Distant' from nearest well---—----Distance from foundation---42---------Distance to nearest lot <br /> Seepage Pit; Distance to neerest well----- -------Distance f 9rn foAdafion...jjp <br /> Djst- <br /> nce to <br /> �r '`~^' � <br /> | �\ <br /> � --------- <br /> Cesspool: Distance <br /> Lining <br /> ' <br /> Remodeling d/ i <br /> ' ` I hereby certify that have prepared this application and that the work will be done in accordance with San Joaquin County , <br /> ordinances, State laws, an rules,and regulations of the San Joaquin Local Health District. <br /> ct <br /> (Signed)------------------------A__�----—---------- - ------------------- ------- -----------------[(�:bwwer.. r Contra or <br /> -----------r,-------------------------------- _20------------------------------ <br /> (Plot plan, showing size of lot, location of s m in rel�ation to wells, buildings, etc., can be �Iaced on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> ' '^ ' �`~`''~'` '^~�� ' <br /> , .^,.E,,^~ .. <br /> � ~~.L~.,~ . ^..... ISSUED <br /> / Aoe,mnons nu/ .—_._—_— _-- <br /> / .��./�`^__-�.�z�'+���—___ <br /> . _ <br /> '^---— --''-'---''—'—'—''------------- <br /> --------------------------------------------- -------- ---- -----------------------------/ --------------------------------------------------------------------------------------------------------------------------- <br /> -- ------ -'— '----------------'----'—'-------- <br /> --'''--'—'—''''—'' ''---'—''''—'''—''--'''--''--'—''---''—''—'-- <br /> —�� ^�1� _ <br /> �m*L |mSrE~/ Date—..+�..-,���c. ---"5_��-----._-----_.� <br /> SANJOAQU|N LOCAL HEALTH DISTRICT ^ <br /> . . <br /> � 130 South American Sfree, 300 West Oak Street /sz Sycamore Street m|* North ^C^ Street <br /> ' � <br /> Stockton, California Lodi, c°x.m. Manteca, California Tracy, California <br /> ES-9-2M . x°.i"va 1'57 p.p.CO. <br />