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-- <br /> FOR OFFICE USE: <br />----------------------------------------------------- <br /> Th' P E'Pires'l Year Fiom Date Issued Date Issued 111.74. <br /> o�_aquin_Local'-Heaf District <br /> Application1i heir;b� made to the San J , I h" for a-permit to c:-o ct and install the work herein described. <br /> This application is_made-in-com_pIia_nc_e_ with County Ordinance No. 549. <br /> JOB ADDRESS AU LOCATION.... <br /> Installation will serve: Residence Apartment House E] Commercial [] Trailer Court El Motel [3 Other El <br /> Number of living units: Number of bedrooms .3- Number of baths j... Lot size --------/ -47��-----------— <br /> Water Supply: Public system Community system [-I Private [A Depth to Water Table -------- ft. <br /> Character of sail f* a depth of 3 feet. Sand d Gravel El Sandy Loam [I Clay Loam Clay [I Adobe 0 Hardpan U. <br /> Previous Application Made: jif yes,date--------------------I No [] New Construction: Yes [] No E]' FHA/VA: Yes [] No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Dispcis�i,ld: Distance from nearest well'----.5 ---Distance from foundation-----1A........Distance to nearest lot <br /> Seepage Pit: Distance to nearest well--------_---------_Distance from foundation------------_......Distance to nearest lot line--------- -----— <br /> Cp <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Court <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District.. <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings. etc.. can be placed on reverse side). <br /> 1.FOR DEPARTMENT USE ONLY <br /> AM�rw��n� an�/�r �-----_—_---_---_.�_—_------'----_'-------''-----__—_—' <br /> ---------------_---------------___-------_---__---___---__---_-----___----___-------_---------- ----------'--__-------------'--__--------_------------------'--------_----------------------_-- <br /> -------''--''--''''—'—_—'—'''—'_''—'''—'''' ' � —__ -------------------------------------------------------------------------------------------------------- <br /> - —'--._—'_.—'—'_—'—''_'---.--- �-----.I --'^—_--''|---'''__--'_--_—_-------.—__—_ <br /> --------------- --------------------- ------ -------------------------------=n------------------------------- ............ ............... ............................. --------- . <br /> ~ .flNAL INSPECTION - -------------------- Date-------- ............................................ <br /> SAN JOAQU|NLOCAL HEALTH DISTRICT <br /> vwwSouth American Street 300 West Oak Street ,n*Sycamore Street 20uWest 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> "" vREVISED °°° w° "'^/ ","= � <br />