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FOR OFFICE USE: <br /> ' | <br /> IT Permit <br /> pC~'v,�'~ 8afm |�um6 <br /> - - <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work heje�n described. <br /> This application is made in complianc ith C /WP NrEc�) <br /> e� I o u,NO rd' N 5 4 9. <br /> JOB ADDRESS AND LOCATION--- Na-- -----W-1V.....LVrOt .R <br /> Owner's Name------ --7-D-NY (f A MY r-Aff: � ............. Pho;e-----­---------­-----­- ....... <br /> Installation will serve: Residence I[Er"`Apar��hent House E] Commercial [] Trailer Court El Motel [] Other F1 <br /> Water Supply: Public system [I Community,sys M-;41vate E] Depth o Water Table ...P. f f. <br /> Character of soil to a depth of 3 feet: Sand J�y Gravel [j <br /> dy Loam WClay Loam F] Clay Adobe[] Hardpan C] <br /> Previous Application '`a~~' `^ ,~~'~~'`--------'` '`~ W''-' Construction:- - Y- =� - ^~ FHA/VA:' Yes C No -- <br /> ' 'TYPE OF-INSTALLATION'ANDSPEC1FICAT#ON ` r7 <br /> (No septic tank or cesspool permitted if public sewer is available within 200 fmwfJ <br /> Septic Xnk-. Distance from nearest I well----:��----Distance from foundation---J-C----------Material---- <br /> Disposal o' Distance from nearest from ,oundan <br /> Number c� | - <br /> . R Type of filter material.-I 1 <br /> Seepage Pit: Distance fo nearest well----------------------Distance from foundation-------------------LDistance to nearest lot line----------------- <br /> Number of <br /> Num6a, cf pits--------------------- '---'--''Size: Diameter-----------------------Depth------------------.'---- <br /> Cesspoo: ' u/mnncn from <br />/ El ' Sm=' Diameter. <br /> Privy Dhtun u�+unoo from nwnny� u��mg-_---____.-_-- <br /> �� �.~...~ .~ .~~.~.'-~ - ...-'''--_''''--'''''__-_..-_.-___-_---___-_-.._'--------_-- <br /> L 1 � <br /> �^ � � <br /> Romo6�ing 'no/n, repairing Waac6bek.'---_-___--_____.--___.---'----'------'-_.==_. --------------------------- <br /> --.______.__.._..__.____''____--.---___-__-__-__------_.'-''_'-'''_---------'--'-_'__'_ � <br /> ----------------------------------------------__............` ________________________.________..______ \________.___ <br /> -------------------------------------------------------------------- <br /> I hereby certify that I will bedone in accordance wif §inJomquin County <br />� <br /> ordinances, State laws, and ru�w,5 ' <br /> ~-"'--"- '~' (Owner-and/or Contractor' - <br /> . � <br /> '__''-_.'-_-_--''''-_.'''�_�. - -------- <br /> ��. �� � �� ���'� ��m � ��� � *�� ���� be �m� on �v�� o�mL. _ <br /> FOR DEPARTMENT USE ONLY <br /> « <br /> FINAL (N3PB�T�] -.1-1=^m������ � Du��.-..`�_ -- -------- <br /> -� SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> 1unwWest Oak Street 12wSycamore Street m0wWeil 9fhStreet <br /> ' <br /> Stockton,California ' Lodi,California m=9COr California Tracy,California <br /> ,/ <br /> ES REVISED n'xnmmm'azATLAS <br />