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' ~ <br /> ��\� <br /> U ApP[1 �� FOR ~. - 'UA|IOP4 PERMIT <br /> ^- '' inDuDuplicate)- - <br /> he San Joaquin Local Health Dist for n permit to construct and install the work herein described.o �pp"^==' �s hereby made to t� i |l ithC t Ordinance No 549. - w- <br /> This <br /> Installation will serve: Residence [I Apartment House [I Commercial Trai�er Court El Motel El Other [:1 <br />' <br /> Number of living units: E] Number of bedrooms F1 Number p+ bo*m L� �ur uz;._�_-.-�__._---_--___�� <br /> Water Supply- Public system ' ' Private 0 <br /> Clay Loam El C\uy [] Adobe Hardpan [:1 <br /> Character of soil fo a6eofhp* 3 rqm`, Sum6 Gravel F Sandy Loam 0 <br /> ' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS- <br /> '`~~-~~^ |C>NANDSPEQF\CAJ|{JNS- <br /> � � pm6Ucao�er � uvmka�� ��Gn ��� fwmt} <br /> U�� oop+� tank or nos�pou/ penn/n=p . ��� 7' < <br /> ` nearest 8 ----- Distance from foundation -.Material----- ~ ` <br /> Tank. Distance from nonrus .°e ----'-- Uqu�� 600+ �� ��"`-- <br /> - No. nncompu�ment�_-'°2�--,-_Cupacit^..-l-�uqa�-..u/ne-(��� ).^°��'==- . .----��_- <br /> Co,`�p]o.o: D|�unoa from nearest well--------------r-.D[stancnf,om <br /> foundation--_--.-_ <br /> Lining muforiul------------------------------------- <br /> F-1 <br /> ----.----------_^1 S��� D�mmtec_'___'.�__--__. ----------------------------------------------------- <br /> Privy: <br /> ''-_.-'''�__ <br /> ' '' ' Distance from nearest well------------------------------------------------- from nearest building------------------------------------------ <br /> Distance to <br /> . .--'-_.'�-'Distunceto nearest .,t line <br /> | <br /> mro <br /> , lot |�e-_--'_�- <br /> ~��q~�p�«�g�v p�' Distance to neona� pvL'---------'D6fnnce from foundation -[�,��oe +o no <br /> Number of p|+� '-] |»g mute��o| S�a' Diameter—— �_De <br /> pfh----.__-._-- <br /> LJ ~^ / u� |o+ |�no _~-�__ 6M1 <br /> �� ��6o '_ � .�Di�on +o nen* <br /> Field: Distance from nearest well -- --D��n� / <br /> Number of lines �^ /" <br /> Length of each line S� -�+ , * i6+h of �enco_— ~.- <br /> Tv of filtermotn v� <br /> _ <br /> Depth of filter -material --e, -~- <br /> � <br /> ` --__-_____----- <br /> plication and that,+he work will be done in accordance with San Joaquin County <br /> ! ' hereby— certify that prepared mfthe San Joaquin Local Health District. <br /> ordinances. State laws, and rules and regulations <br /> _.________.____.____ and/or <br /> ` ' - ' . ' ----..__-___-.-__'_- <br /> ----'-'''''-`'''' ''----��� ' bo ' ��� this-"----'- ��evf�� location 6uU6�q� nt�, must filed pp"~"ti <br /> =+ <br /> /P1mfp|mn� ohm*n� . mna . <br /> FOR DEPARTMENT USE ONLY <br /> � 8 (� �������!��{�/~ -_-___-------- DATE-.�,�.---'---�-----_.--__._-. <br /> APPLICATION *�u�r��u --� _____�_______ D�TE_..�~.����''I^�-----------' .. <br /> KEV|EVVBD BY �� ` ---- <br /> < __X�.�� �� -.-'_--'-_ D�TE____.''--'__.''_-''_-'-_-' <br /> 8U|LD|N(� P���w|| |��u�u_._�z�.��.-.. -_-_--._--_-__�� ___________________.____ <br /> I Alterations and/or ,omommen6at�no�----_------_---_---_-__-_--__..___.___- __._._____.___________.. <br /> ! ____._________.__----___'''--'--'---'-------'—'------------''-�_ ._ ___._____.____ <br /> . .-_----------.-----_---_---------'_-_'------------------ �_-__-__.-__'-----_----.----:------. <br /> ' <br /> : --_-_--__�-_---_-___.__-_-___-_.___-.-________-���� _--..__----_— <br /> � -__--__.-'_-----_-__--_..__.____--.__-.____.__�.------'-_--._ <br /> ^0-`-~M|T N |3SUB] -.__...(Dute) RN/\L INSPECTION BY:---___--._---__--.--_- <br /> Dufe-''--''---'''�----'--'-'----'--'--' <br /> [ <br /> SAN JOAQU\N LOCAL HEALTH DISTRICT <br /> 130 South American S+n»e+ <br /> � <br /> / <br /> Stockton, California , <br />