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| <br /> � <br /> ^ Qw- <br /> FO MR OFFICE USE., <br /> R CE USE' <br /> Offi <br /> Application is hereby made to ito SXJc"Wqu'in Local H`e`a1WD;drict for^pomit to construct and install the work herain do=13ed. <br /> rice Vith County Ord;nance No. S49. <br /> JOB ADDRESS ANXLOCAT1ON.q4K1A?__4__: <br /> Ownees Named <br /> Contractor's Nm <br /> Irstatlation will =two. Reiiidence ED/Apairtment House E3 Commercial 0 Trailer Courtb MOW 0 Other 0 <br /> Number of living units:1_ Number of beclrooms..!5�_ N be f baths <br /> Waller Supply. Public system 0 C Tm umnpth -to Water Table <br /> � ; r,wvlowwvqvpxcmion °"=Jw= (If v=+d~^e_-----'-~ .~ 0 .-.- `-_-'--..`'- Yes ^~ No 0 _ __ <br /> NO 0 <br /> TYPE OF INSTALLATION AND SPE-i,-IOICAnIONS: <br /> (No septic tank or cesspool paimMW if public sewer is available VdMw2000eee.) , <br /> " � <br /> Septic Tank: D�*xm: from "en,mu ~�� Distance from , ^ <br /> [] <br /> No. of <br /> � <br /> Disposal Field; Distance from nearest well................Distance from fououamnw--^..............Distance to nearest ",, <br /> [] Number of lines--------------.-'--'_-'-Length 9f each of <br /> PitType of filter material........ ....Depth of fifer rnaterial.__........ <br /> See : Distance u/stuncm ,onearest . <br /> Cesspool- wwnan=~ from "="==' "e'----'---~'~''~~~ ^~'` foundafion.....................Lining ----..........-- --- - <br /> 0 Sim. _ -'.-___'-_------'_-_u�u� Cm�m�n�.^�_~__._-'_��w <br /> � ? � ' °--' <br /> p+�y� Distance-from nearest .......Distance fnxm nearest building. ^ <br /> 0 Distance tonearest lot _...... ....__...... <br /> � <br /> Rmmndmflmg and/or repairing (desc,ibm);------_ ___-~'-._.....-............... <br /> _'--._-_----'-_' <br /> -'--'--...._' ...._......_------'..-__-_.....__'._-_-_--'------_-....._---'_....................................................'_^--_...........-........ <br /> ' <br /> 1 hereby certify fha ve prepared this appOcaflon and tha+f6 waA will 6 done in accordance W"h San J60quin County <br /> ordinances, State laws n rules and requ6ti of the San Joaquin Local Health District. <br /> (Plot plwn, q of lot, lo "°= in fia~ .~wells. buildings. -_, can be placed_ an reverse ---' <br /> FOR DEPARTMENT USE ONLY <br /> o�;�- <br /> R��GwvED BY. _____ __________________�___�_________.__ _____________________.___ <br /> | <br /> BUILDING _'._-'_ Dvsc�_- � <br /> ' A*er*fi*mmmd/mr ............................------------------- ------- '=-.................. ---------------'-~-'­!'-;;�-'...------'---- �L <br /> -_-_--_-_------.__-_'--.._-`-_...----..-.....-_-.----_-'-_-'-----'---__-.---_'_----.-_-_...._ ....... <br /> _--_-_-.--.--.-'_--�-_--_'/--_--_------_''-'--- ----------------'-- <br /> ` <br /> FINAL INSPECTION � � ` __._________ <br /> ' » . ^ . = - - - � <br /> SAN JOAQUNNLOCAL H@ALTH DISTRICT ' <br /> | K y <br /> 130wourbw°owka°**W 300 W*dOak m*"ot 1mwSywormmShow 205 Wool 9th Strew <br /> Stockton,CoMmle Lodi,mwiFornia mante= calihmia Tracy,Cowwrilia <br /> uwvItm*,wsn w'5= z04a-6oATLAS <br /> � <br />