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140) I, licisoitan Avo. <br />Stockton, California <br />CS 9 PtlitlitO 13.99 3M F.P.CO, <br />300 Wass Oak Stroot <br />Lodi, California <br />124 Sycamoro Stumpf <br />Mentoce, Ca I i form ia <br />205 Wait 9th Strottt <br />Tracy, California <br />Application is hereby ma' <br />This application is made in corn <br />JOB ADDRESS AND LOCATION <br />Owner's N <br />Address.. <br />Contractor's Name_ <br />2Va 11-60,AA 420 rd <br />APPLICATION FOR SANITATION PERMIT <br />(Complete in Duplicate) <br />This Permit Expires 1 Year From Date Issued <br />n Joaquin Local Health District for a permit to construct and in <br />ith County Ordinance No. 549. <br />fat <br />Permit No. <br />Date Issued ... ........ <br />the work herein described. <br />a -7 ,,t) <br />r)firet.Z.Z.z.lfr-niga2- <br />Phone <br /> Phone <br />Installation will serve: Residence 0 Apartment House 0 Commercial 0 Trailer Court 0 Motel El Other <br />Number of living units: 'Number of bedrooms Number <br />Water Supply: Public system 0 Community system 0 Privet <br />Character of soil to a depth of 3 feet: Sand 0 Gravel 0 Sandy Loa <br />Previous Application Made: (If yes,date _ .. .... ..) No a New Construction: Yes 0 No 0 FHA/VA: Yes 0 No D <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br />Distance from nearest well.totiff Distance from f oundation Ivla • <br />No. of compartments. 02.- Size.3 '3 1- Uquki depth Capacity. <br />: Distance from nearest well e) Distance from foundation /0 <br />Number of lines. Length ofeach fine width of trench <br />Remodeling and/or repairing (describe)• <br />..„ <br />I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br />ordinances, State , and rules and regulations of the San Joaquin Local Health District. <br />baths . Lot size — <br />epth t er Table ft. <br />Clay Loam 0 Clay 0 Adobe 0 Hardpan 0 <br />Type of filter material...J..57,e. .........Depth of filter material.....f.9 # Total length r 7..." Distance to nearest well ,rie.)_.0 / Distance from foundation_ .../.0 Distance to nearest lot line.-. <br />,..› <br />Number of pits_ / Lining material, --ti If Size: Diameter 3 3 Depth <br />Distance from nearest well__ . . ..... __Distance from foundation_________Lining material..................... <br />Size: Diameter Depth Liquid Capacity gals <br />Distance from nearest well Distance from nearest budding <br />Distance to nearest lot line <br />••"! <br />i043015-- and/or Contractor) <br />fritte) <br />, buildings, etc., can be placed on reverse side). <br />DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY.... <br />REVIEWED BY <br />BUILDING PERMIT ISSUED <br />DATE. tr•S <br />DATE <br />DATE <br />Alterations and/or recommendations: <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />Date. <br />Cesspool: <br />0 <br />0 <br />1-D <br />ltSs' <br />€.• <br />(Signed). <br />(Plot plan, show g size of lot, location of system in relation + <br />FINAL INSPECTION BY:., <br />tJ <br />FOR OFFICE USE: