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APPLICATION ��� ��� �m� Nu -J����� <br /> � ru�^�^�n^ FOR ....,,.,,. ������ p <br /> in Duplicate) 'Dote |muo6 ' <br /> work herein ide:scribed. <br /> gplica4-ion is'hereby made to the Son Joaquin Local Health Dist rict for a permit to construct and install the <br /> is application is made in compliance��ith County Ordinance No. 549, <br /> JOB ADDRESS AND LOCATION-,fi0l' <br /> Owner's Name------_---------jo-d,4------0 . ....V---- ------ - __04��_ <br /> . U t <br /> 11411 Other El <br /> Installation will serve: Residence 2--`X`partment House E] Commercial El Trailer Court E] Motel 0 <br /> Number of living"#*unifs: _1----- Number of bedrooms J--- Number of baths Lot size -------------------------- <br /> Water Supply: Public system El Community system E] Private F� Depth to Water Table -------- ft. <br /> Character of soil da depth of 3 feet: Sand El Gravel F1 Sandy Loam 0 Clay Loam [j Clay El Adobe 0 Hardpan <br /> Previous Applic4 Irion Made: Yes [-] No FT New Construction: Yes E] No 0 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> �'[Nclsepfic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> D.-isposal Field: Distance from nearest well_A0V_, Width of french_.j_,v4 ................. <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- <br />` Remo6oing and/or repairing (dn=cri6o):---------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------'---'-----'-'--'-' <br /> . -----__-_--_-_-._-_-.-_._-_.__.-_-._____-._--_..___-----_-_-._'---''--''- <br /> --'-''''---'''-''--''--'---'--''------''''-'------''---'--'''--'--'---''----''-'----'-'-'- <br /> '--- that \ 6 prepared application 6 that t� work will be done in accordance with San Joaquin-County <br /> | hereby certify that e°� p,epmrw opp �m nn mn a ew� <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (CJ�ne, \ <br /> ---------- <br /> (Signed)--------- <br /> -�n'.--u��. -----------.,---`--------------` <br /> 9` _r_9 -----..[[�e)--'---------------_--.-my;.' ----------'-----'----------------------�� (Title) - <br />� (�wtn|wn. �6*��� o6m of �f |o�m�*n *foyo em in re�+�n +n w �. 6u ��g�. ���. can 6w ���a6 on reverse �6o� <br /> _^ .~ - . _' --- -~~~ -~~ <br />~ . ~. <br />� '`^''~' E~ ~''—''-''-''�- ------------ <br /> DATE BUILDING PERMIT ISSUED'-'''-'''---'-------'-'--''-''''--''---''__' ___�__._______________ <br /> Alterations and/or recommendations:--------- ------------------ - ------------ ---------------------------------------------------------------------------------------------------------- <br /> _. <br /> r _� _._________________�____________----'-_�--__--------------''-----''----- <br /> , -''-'--'''_--'''--'-'''-_'_'''_.-'--'--'''''''---�'''-'''--''--'''-'''--''''-''''-''_-'-'-' <br /> ��_�_�__�_���� _��___�___�___�___��____��� -�_��__��___�__����__�___��_____�_������_��� <br /> -- -------------------'''''- ------------------------------------------------------ -------------- <br /> ` (���7 <br /> _ <br /> FINAL INSPECTION 8Y�-' ------------ -------------------- Dm#�-��l.|~»7.�1�]L--------._.---_� <br /> SAN JOAQU|NLOCAL HEALTH DISTRICT <br /> ~� <br /> ^ amvv°mo* ��� |xo Sycamore m4 North "C" Street <br /> - ` /xo s""� American ��� � "r, . <br /> ` a�"��". C^na,,"� Lodi, California M^m�a. oa|Ho"o° Tracy, California <br />