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FOR OFFICE USE: <br /> ----------------- <br /> (Complete in Duplicate) Date Issued <br /> plication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> is application is made in compliance with County Ordinance No. 549. r- jjq­ <br /> 4. <br /> JOB ADDRESS AND LOC�AT�1ON._____911k _yf 1�;3- 330-06 <br /> Aprr -----------------------------------------­------------------------------------------------- <br /> Installation will serve: ReFside;nce JZK parfme"nt House Commercial F <br /> I Trailer Court 0 Motel El Other E] <br /> Number of living units: __/... Number of bedrooms -:4-. Number of baths ---/.. Lot size --------7j� <br /> ----------------------------- <br /> Water Supply: Public system C3 Community system E] Private'Do, Depth TO Water Table,?O- ft. <br /> Character of sail to a depth of 3 feet: Sand El .Gravel 0 Sandy I-oamM Clay Loam [] Clay El Adobe[] Hardpan <br /> Previous Application Made: JIf yes,date--- --------------_) NOR -New Construc-�ion: Yes X No E] FHA/VA. Yes [] No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 4 <br /> (No septic tank or cesspool permitted if public sewer is available wifhin 200 feet.) <br /> Septic Tank: Distance from nearest well--S-O-/---- -ation. / ... <br /> Distance from found ---AO-Z-------Material---4�1 <br /> Disposal Field: Distance from nearest weR.__f_0'___._Distance from foundation__A?�---------Distance to nearest lot line_ K......... <br /> Seepage Pit: Distance to nearest well--- <br /> Cesspool: Distance from nearest well-----------------Distance from- <br /> '--------'''--'—'-------------'------''-------'---''----------------'--------'----'- <br /> - � <br /> __---_----_�.'---__.--_-_-�---_--__''-_'-_.'__-_--__.-___'__...__-._-_ <br /> -.._-'-_'--_--__--. <br /> ------------------------------------_------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> / hereby certify that ohme application at the work will be done in accordance with San J�� �� <br /> ordinances, State laws. and rules and rwgu|a�nns *fthe San Joaquin Local Health Di�r�+. ` ' <br /> ` <br /> (Signnd)--._-'-_''____ <br /> � p,Wner and/or` Contractor) <br /> Kqo+ ��n ^���� �f u� - - ~ - ^ -''-'''-''`--' ----- ~'--'-'----''--' <br /> ` '��~ �� �~. ' �� system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR REPARTMENT USE ONLY <br /> - -------- <br /> REVIEWED -'--------------------------------------------------------------------------- ----------------------------------------------- DATE.'-_'__ <br /> BUILDING PERMIT ISSUED------' ` -------------------------------------------------------------------------------- .. DATE--_ �--' ----'-'- <br /> Altormiionwmn6/mr._______D_._�L..' ._���������-_�- �_ �___-_--_--.--------__ _'� � - -----' ' ' <br /> ~ ----- ---''-''--'--''--'--_-'---__.'_-'' <br /> -._--_----`-'--_-_-_----.--.--__---__-_-_'----__--'_--_----_-----__--------------- <br /> --------------- <br /> --''--'-''—''- <br /> ���'- -'-''''-''---'----'-'---''---'--'----^''--- <br /> .-'--'----''-----''--'-''-.- --''--''-'----''---'--'-''-'-'-'''_---'-'--_. <br /> ` <br /> RNAL INSPECTION BY:---- - -_-- Duh�---'' 1�� --------'—' <br /> SA� JO���UNLOCAL HEALTH D --MCT <br /> 130 South American Street xn0w+ww"kw�° , '� 124wv�m"�S,�m uwxWem9�S�°° <br /> Stockton,California Lodi,California ma"wm:,Caommia Tracy,California <br /> cs 9 nEv/oco o'59 2m x'vz ^,L^w <br />