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� <br /> FOR_QFFIFE USE: <br /> �3| 30 <br /> / r��� ���m� wn^ ' <br /> �� �����UK���'���y� rv�� ���7�Y���/»��r� ��mn�nn -, <br /> Dm+o Issued -~ <br /> ] � <br /> � � <br /> Local Health District o permit to construct and install the work herein described. <br /> \ <br /> �np\om6on lo ��rw6v made to co eu ' <br /> ' -'application is made in complia ce with County Ordinance N 549 <br />` <br />� -_- ADDRESS <br />� <br /> Contractor's N _- � - + <br /> Installation will serve: Residence ER-`IA-partment House E3 al [] Trailer Con ._' <br /> Number o, o,/"y units: ^"-.. <br /> m � �,.^ ~~ __---_- ' ber of baths -Lot size <br /> ' ^ <br /> �� Still �'' p�� ��m m�r� �� � ��� s��� � ��r � <br /> rr <br /> Character wfsail tom �mm+� of 3 few� Sdn6 LGravel [] �6mn6v Loam[I CoyLou- a- ]mv [] Adobe __� <br /> � <br /> ] <br /> ` <br />\ <br /> Yes R- No [I <br /> Previous Application Made: (if ves'6ote------.)-lqo P�~ 'New Construction: Yes ��-mv � FHA/VA. <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: -- � ' <br /> (No septic tank or cesspool ' M+e6 if public isavm[������n 200 feet.) � <br /> S�-ptic Tank: Distance from nearest w /4A9_Distancp from jpunc1ation__._AZ7---------Mat 'f....... <br /> | N�- '`°' of ^°'^p~''^'~'''^-=~--'''--��- - ''- / lot || ~X:." <br /> Disposal Field: Distance from ne"arest well---------Dist6nce from founclation--Aa--- Distance to nearest <br /> gj,`� Number of lines.- ----- ------- epth of filter material ------Total length...- <br /> Type of filter rn,�;.rw. <br /> Seepage <br /> Distance to nearest /A�70_" Distance fr foundation__ZA0_-------Distance to nearest lot line-4---------- <br /> � Number of pi1$..'-._ .--.-un = <br /> /nq mu. .".-*~°"~^°^~._--. -_-- ���_ . <br /> \ ~=s"p"°'' Distance from neu,o, *»|L- Distance �omfpwn6u�q" - Linim@ material ----__-__] Size: D|&��fer---- -----------------------------Depth---------------------------------------------------Liquid Capacity----------------------------gals.. <br /> | u|�un�� from "'n' *nsfwe|| ' Distance from nnonn� 6uU6�g.--_--_-_-__-- <br /> Pr�y' = <br /> ' � �tU ---' ----'--'--'----'-' <br /> Distance to <br /> ' <br /> |}` xam000~/ma u""/"' ""p= '—y (describe):----------- <br /> I <br /> —/ �»". �__.__ ------------------------------------ <br /> ------------ <br /> ___ <br /> .___________ <br /> '-'-- --'----------''-'--�'--''--''-- __ �. _______________�_`_ <br /> -~_. '-------------''-' --__------------------------ <br /> - <br /> '__-_--_-..__..--_---_-__-_--__-.._�_--_--___-' <br /> ---�-'.__---_---__ _ '---_--.-'_-_-.--_--''-.-_----- <br /> ------- - ---- '----'---- <br /> ---' '" =°r ~~^ , ' - '' d that the work will be done in accordance with San Joaquin County' <br /> �\ <br /> ordinances, State laws. an 6d regulations of the San Joaquin Local Hearth District. <br /> rules a <br /> � <br /> \ <br /> (Signed)-------------- _,��rm�- ------------- <br /> � (Title)- <br /> (Plot plmn showing site of .". location. of sy, in relation to wells, buildings, etc., can 69 p aced on reverse side). <br /> ��E�ARTMENT USE ONLY <br /> \ ' <br /> APPLICATiON ACCEPTED <br /> - uEvIEvEu BY - -- -'--'-'''''`^--''7'-��� <br /> DATE <br /> Alterations and/or '~.~^^^~^~~^-_______"=~._,_________~ .______.___.____________________.___. <br /> � -'-_'-._'-_- �_-. --- -----_-._.�------_��_-_-_._-_.___-.--------_-_. <br /> � -_--'-----''-''-_''--'_-''-''' ------''''-''_-''------.---''-------''---''_-'---'''-'''-'-'-_ <br /> / -'--'- ^ '_. . <br /> �� �� ------ ' <br /> ` D���z�=`��_- '�~' '---'--'- . <br /> HNAL |��SP ~_ � <br /> { ---- <br /> | �AN JOAQU| LOCAL MLTH DISTRICT ~ <br /> / . <br /> �w����p�xw�°° -1z4��m"=soe° unmW°m9me�° <br /> �ow�"��=°��"m�w� �°° <br /> � Stockton,California Lodi,California Ma"'oto'can*","/" I=p'.xaxw,rnia <br /> ~.. . <br /> ' "" v =n=" v^w uw a.w ATLAS <br /> . . � <br />