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�-^ <br /> � <br /> ���� Pom� N� � <br /> APPLICATIONFORSANITATION . <br /> . <br /> (Complete in Duplicate) Dofo issuedApplication 'is hereby made to the San Joaquin <br /> Local Health Dist rict for a penn|+ to construct and install the work herein described. <br /> This application is made in compliance with Countyp rdinanc No- 549. <br /> ------------ <br /> Phone <br /> Installation will serve: Residence,19 partment House 0 Commercial [] Trailer Court El, 'Motel 11. Other 0 <br /> Number of living units: _f__ Number of bedrooms _,Z_ Number of baths __/__ Lot size -1 ----------- <br /> Water Supply. Public system Zr-oc"mmunity system E] Private 0 Depth to Water Tabie ft. <br /> _Zt pan <br /> Character of soil to a depth of 3 feet: Sand El Gravel El� Sa�dy Loam El day,Loam [I Clay [] Adobe 0''Had <br /> Previous Application Made. Yes E] No A,-�, New* Construction: Yes R-<El 4HA/V I A: Yes ZL_�� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS <br /> (No septictank m/ permiffed--if public sewer is available within 200 fee <br /> ~ well-14OV&Dl <br /> _., _:.......S. P4.— , I� <br />� - U omp from rvu""="" ,,"^ <br /> mb~� N be of line!;-.!--- L='y^' ~' ~~~' -- - - <br />� of filter afe7Vicitk of train <br /> r /��c u"p". ". filtermaterial- -�'--_---"'-Total _ . <br />' f fo <br /> Seepage Distance to nearest wefl,____7777T:Z�-----Distance <br /> - " � a ` ~' <br /> .-� � �Wum6orufpiAl K <br /> Cesspool: Distance from nea= °n `/''-'�-Distance from foun6m+�� - - �n/ngino��rm�.---'-'- <br /> -'� <br /> ___�quid Capuci�'_------''nam-' n <br /> F\ <br />� Diameter _-"-e.p <br /> El <br />| ' o�m ' �� <br />� ' � _+. .- � <br /> El <br /> \ ' <br /> Remodeling and/of repairing (desCri' 6�)­�-�- � , <br /> ` _----____.''-'�_''-_'_--��-�__-----'''__.`,---_-'-_-_'----''-� -.----_.-�_---_-.�-------' <br /> [ '-__--.-__-_---'-_'--. ..�...------.--__'-_.-_'''-_-__'__��' -_--__---_--.`------ <br /> � --''---'-------'--'---------''' 6* �n accordance with San Joaquin County <br /> ------------- and that the workw0 6�nm a n�� <br /> I hereby certify that I have prepared this application <br /> ordinances, State laws, an <br /> ------------------------ <br /> ---------- -------- w Ils, buildings, etc,�an be placed on reverse side). <br /> (Plot plan, showing size of lot, locafion stem in relation to e <br /> FOR DEPARTMENT USE ONLY <br /> �| <br /> APPLICATION ACCEPTED BY- | �� �^.0-----'--_.- .. - � D�TE''-� , <br /> '---'---'- <br /> - D/TE'--'--'--''-'--'-�----''� <br /> RBUEWEDBY' -------------------------------- _---'�__-_.'_ _ . <br /> | LD|N�' y�wm// /x�u�u '.--'- . <br /> \ _6��/ ���»��^ --'^^- -- ---'' ' __ '-��- �------''-- <br /> ` ---_----j `_-+^~`'---_�________._______._____._________ <br /> [ � ` Date------- <br /> SAN <br /> _______________ <br /> �N/\L |NSP ]J�- '' --x � <br /> SANJOAQU|N LOCAL HEALTH DISTRICT <br /> ^ ^ `eamore�,�� ��� 814 North "C" Street <br /> 300 West Oak_�treet <br /> � '�3S. _j <br /> rmo» California <br /> Stock+on, California Lodi, California <br /> � ! <br /> *s-9-2w x°.a"a 1'57ppCo , <br />