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��� <br /> ` APPLICATION FOR PERMIT Pnnn� No. -�� <br /> � <br /> (Complete in Omn�cafe Date |�u*6 _'//r/I"y <br /> �Application - hereby mn`cletothe^�-Sa' n° l � Local Health Dist 6otfor op�nnit foconstruct and install the work <br /> ��herein described.6o�. <br /> This applicatiori is made in compliance with County Ordinance No. 549. <br /> � <br /> ------------------------- <br /> Phone <br /> er <br /> Commercial E] Trailer Court 0 Motel El Oth <br /> Installation will serve: Residence Apartment House El _i- _ <br /> Number of living units: ----(mber of bedrooms I----- Number of bafhs -_I---- I <br /> Water Supply: Public system Community system 0 Private E] Depth to Wafer Table -,f-0- ft. ?A, <br /> Adobe -Hardpan E] <br /> Character of soil to a depth of 3-feet: Sand 0 Gravel Sandy Loam El Clay Loam El Clay El <br /> Previous Application Made:. Yes F1 No F1 New Construction: Yes El. .'No 11 PHA/VA; Yes 0 No D <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) <br /> S e-opi Taa�., Dislance from nearesi well-----------------Distance from foundation--------------------Material------------------------------------------------- <br /> Dispo -4 aresf we�1,101_ -.Distance from foundati J10- Distance to nearest lot line <br /> ittd- Distance from ne <br /> Nu 7ir <br /> Type of filter material----------0_f�_C---Depth of filter material <br /> See a e Pit: Distance to nearest �,Il ------Distance fxQm foundation- -----------Distance to nearest lot line--- ---------- <br /> Cesspoo�: Distance from nearest well----------------� Di5fance from founclafic <br /> ` n°w""e "'y and/or� '~r`^^'g (desr----' <br /> _________.___.______`__ <br /> _ - ~ - ..__.._--'---__.__-_-..__-._-.,-_-_---�.-_�._-------' <br /> '--'-----''----''------''''--'''--''-- a�6 that �o, "�U 6e �mna i� ac�o,6uonaw�6�mn Joaquin County <br /> of th�' San Joaquin Local Health District. <br />' / nv,ocertify "^~' ' '~`~ r'-r--- u <br /> (Plot plan, showing size of lot, location of,sysfem in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br />' D�TE--' --------------------------------- <br /> APPLICATION <br /> ______-_____ <br /> °' ' L^~`''~'` ACCEPTED - '- ��� ' DATE _�____________�� <br /> kEV|E\�BJ BY------------------------------------ '-''---'-^`--''---''--' '-'---T'-- <br /> - ^ u�/� ------------------------------------------------- <br /> ---------- <br /> '--'-----'- <br /> 8U|LD|N�� PERMIT ISSUED--_-_-__.---�-_--_---_--___-_--_ -----____—.. <br /> A�u,mt�nsand/or r000mmend at�nu -_-'_._------' _������..�.��-._-''-__'''-_-_-'_----'__.____'' <br /> / �' ^*e--. ' -' <br /> � _-z`��. -�--�^s«�`'=-�'',^�^^^'~^r~--''--''--''���� - <br /> \ * . '_~_-_-_----`-,._-.—_--.---_.--__---- <br /> --'-_''--''_--- ' --''___ <br /> ---'-'''-''-''''-^_'''--'-'--'-''-'-' <br /> -------------------------------------------------- <br /> ��/- <br /> � Du+° ���^u7� °��'-------------'' <br /> ' <br /> FINAL |NSPECT|O ��-�'�-��u^w«�" �- -. ' ' - <br /> SAN JCW\QU|NLOCAL HEALTH DISTRICT <br /> � <br /> oo Sv"m Am°a"= Street 300 West Oak Street oz Sycamore Streew* North "C" Street <br /> Stockton, California Lodi. California wa"few. c°|aomi° Tracy, California <br /> cs_9-2M . novaoci 1'57F.pn0. ` - � <br />