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� <br /> -0 <br /> APPLICATION ' -'^ S^`^""'A'"ON rEmMox Permit No. <br /> --- (Complete in <br /> Application is here <br /> by made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> ~`~~ ^`""~=+S nN <br /> Address <br /> --------------------------------------------------------------- <br /> Installation will serve: Residence Apartment House [:] Commercial [] Trailer Court [] Motel Other <br /> .=.b", of living units: -/_ Number of bedrooms 'x9. Number of baths� v- Lot size ------' ' .-~ <br /> ----''------� <br /> '--'--''Va+er Supply: Public oyoh*m 01- --un system [] Private [] Depth +nWafer Ta ' �Chmnm�erwf soil to m depth of feet: Sand [ Gravel [] Sandy Loam [] Clay Loam [] C|-' [] AdobeZr~''mn6pao CPrevious Application Made: Ufyes,6owyyq-$---'') No [ New Yes [] N» Q1~ pHA/VA' Yes [] Nm [] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS; <br /> r (No septic <br /> i <br /> - <br /> tank orcesspool permitted if public sewer isavailable within 20O feet.) <br /> tic Tan Distance from nearest well-----------------Distance from foundation <br /> '----�Mu�rim|Nu o{ �ompurhnen�. -_-_��n_-. _.--'__Liqwid <br /> ----'----'''---'---- <br /> clop�h--------------------------Capacity....................... <br /> : Distance from nearest well-----------------Distance from <br /> foundation...----'-D�tuocm to nearest �t |�w- <br /> '---- <br /> Number of ||�a. -_------.Leno ' of oorh line _ ' ---Midf^ offrmnck7ypo offilter material <br /> -'--'-- <br /> Total <br /> th <br /> Seepage <br /> � ' ' " �� o--- ^=='="' '"'PT Number of pits _ - Un�g mofo,�| �^� Soo� u ��n* � Depth J# <br /> ........... <br /> ~i <br /> -Pit: Distance to nearls`� - <br /> _10 Cesspool: Distance from nearest well-_---'Distuncefrom foundation -----L/n[ngmofo6u' -------] Size: Diameter ''------'--'�f ''-'-'--'-'--''-----''L�ui6 ' ' ' ------------ <br /> i* <br /> ---- <br /> [' i — — <br /> .......gals.Distance from npu�, we|L-._-- _-- --'Db+unce from nearest building_-______________D�f »«efonaunsf |of. 1h�------------------------------------ ''-__ <br /> Romn6el|ng ' <br /> oo6/o, repairing kJ*, ����''�----_-.__---..__.''---_--'_._-.'_--------.-_..__.-----_-_-___ <br /> ----------...............--''---'----`'---'---------------------------------''-----------'_-.i------------------------------------------ ---------------- <br /> --__-_--.' � <br /> __._-___.-''-_.-'_-__'-_-_.___.'-_.- '-__'__.._-_-___-._-__--_--- <br /> ----�������''�����'����.����' � <br /> | hereby certify that I have prepared this application and that the work will-be done in accordance with San Joaquin County <br /> ordinances, Sfaf aws. andjules and regulations of the San Joaquin Local Health District. <br /> By:.............................................. ------- / <br /> (Plot plan, showinq size of lot, location of system in relationjo wet uildings, e4c., can be placed on reverse side). <br /> FO R DEPARTMENT USE ONLY <br /> .~-.�^t�. !:i--------------'-'''^_-'---'_---_--------''--'-__-'_-.--'''--'--.__-- -- <br /> -''-'-'--''-''--�--'''''-�-.------'_-'-'''--'---�''-�-'���-��-;�----''''-''_'---_'_-'-'- <br /> �------------- ''���''���''�'��'�����. <br /> FINAL INSPECTION BY: <br /> -- -------------------------- Dute-. ----'-'''-'''-'------' <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street o0oWest Oak w"e° 1o*Sycamore Street 2pxW° ,v�uo�° <br /> Stockton,California Lodi,California Manteca,California r=*°�` "»»�° <br /> "° ° ""n""" °°. nu °'w ",m" 'California <br />