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- <br /> FOR OFFICE USE: <br /> � . <br /> ^ v , Permit No. <br /> ` <br /> Date Issued <br /> \ ^ Application is hereby made 'install the work here n described. ' <br /> ^^' ~n~'~~^~' is ^'~~~ in 0��� � <br /> | / + ww | <br /> ' '~''" 4J <br /> i --- ADDRESS AND -- ---'''-''--'---'-- <br /> / I/ Phone--'''���-' --------- <br /> ------------------------------- <br /> - ' ���` <br /> . "�"="`---_. `����� ^�" ��`�,�-'.~~=~_A.,------_---_------.-----.-... . <br /> ' Contractor's Name---------OVJ&E._K --------------------------------------------- Phone_—._-__----.-.. <br /> / |nohn|lation will mm"m; Residence artmvnt House Commercial E] Trailer Court [j M6+o| [] {]+ha, [] <br /> � <br /> Number of living units. '| ' NuM6or of bo6noomo�� Number of baths '/ Lot size ��� ��J -------------------------- <br /> Water <br /> -''���-�-' <br /> � <br /> Character of soil to a depth of 3 fee !'San� U!rGravel E] Sand-� am E] Clay Loam Clay Adobe[-] Har <br /> Previous Application.Made: (If yes,d -- ---- ---- NO' V�New' C6nstrd6fiOn. e N( <br /> _,__!YPE OF INSTALLATION 'AND SPECIFICATIONS: <br /> Septic Tank: Distanc'e from nearest well_,__5�2----Distance from foundafion_-__�VA--------- ------- <br /> Z I <br /> Dispoial Field.: D�stance.f rorri.pea rest'wel I.......5- e5stLce from foundaJion---�/0--,,__Distance to nearest lot line----15___ <br /> e 1k <br /> I her 'by ify hat I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinancest +e s, and rules and.r6gulations of the San Joaquin Local -Health District. <br /> (Plot plan, "Showin'g size of [of, location of s ern in relafio-n to wells, buildings, etc., can be �Iaced on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> -SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxetion Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br />