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Commercial 0 Trailer Court 0 Motel 0 Other 0 <br />1601 E. tfatelfen AY., <br />Stockton, California <br />s ncvistt:. e-se 2N4 <br />300 West Ook Street <br />Lodi, California <br />124 Sycamore Street <br />Manteca, ColifomIct <br />205 West 9th Street <br />Tracy, California <br /> Materiel Distance from nearest well Distance from foundation <br /> Capacity................ No. of compartments Size Liquid depth <br />APPLICATION FOR SANITATION PERMIT <br />(Complete in Duplicate) <br />This Permit Expires 1 Year From Date Issued <br />Permit No. <br />Date Issued Vi/C <br />Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the wog-lc herein described. <br />( , 6--sei.i.41..J -e- Al....4 / <br />07 This application is made in compliance with County Ordinance No. - 549. <br />JOB ADDRESS AND LOCATION /AA .24d Le1,44:Lie <br />Owner's Name ... (4.414C1Al <br />Address..._;.Z ...... /1.4...9..... • era ... ... <br />XI AO-Ida a4etx- 1'14 <br /> t'Pho'ne <br />Character of soil to a depth of 3 feet: Send 0 Gravel 0 Sandy Loam 0 Clay Loam <br />Previous Application Made: (If yes,dcte No 0 New Construction: Yes 0 <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or cesspool permitted 4 public sewer is available within 200 feet.) <br />Septic Tank: <br />Disposal Field: Distance from nearest well. <br />Number of lines.. __I-- <br />Type of filter material 51 <br />Distance to nearest well /Oa Distance from foundation /0 <br />, Number ef pits :Lining rnaterial . .Size: Diameter <br />Cesspool: <br />0 <br />Privy: <br />0 <br />.Distance from nearest well. . ...... from nearest building <br />Distance to nearest 'ot line <br />Distance f;om nearest well <br />S:zo: Diameter .1 <br />. Distance from foundation... Lining material <br />Liquid Capacity................. Depth_ .. <br />4.. . <br />Remodeling anC/or repa no (descri'oe)• u.g.4-"4-a• -4-21' <br />hereby certify that I have prepared this application a <br />ordinances, State laws, and rules and regulations of the San <br />4t-sie&t- By- <br />(Plot plan, showing size of lot, location of system in relation to welts, buildings, etc., can be placed on reverse side). <br />FINAL INSPECTION BY:. Date <br />APPLICATION ACCEPTED BY.. <br />REVIEWED BY <br />DATE 3 / <br />DATE <br />FOR DEPARTMENT USE ONLY /7 <br />BUILDING PERMIT ISSUED <br />Alterations and/or recommendations. <br />DATE. <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />Clay 0 Adobe 0 Hardpan 0 <br />No EJ FHA/VA: Yes 0 No 0 <br />..... Distance from foundation.— ........... ...Distance to nearest lot line____ ...... <br />Length of each line..... ....................Width of trench <br />Depth of filter material Total length <br />I. <br />is ce to nearest lot line <br /> Depth 5 / <br />t.e <br />fTsi <br />(Signed) <br />that the the work will be done in accordance with San Joaquin County <br />oaquin Local Health District. <br /> ifiggSWIend/ or Contractor) <br />(Title) ... <br />,r1 , <br />Contractor's Name.. <br />Installation will serve: Residence SI Apartment House 0 <br />,derritcc- Phone <br />Number of living units: _L._ Number of bedrooms . Number f baths _ Lot size <br />Depth to Water Table ..... ft. Water Supply: Public. system 0 Community system Private <br />• <br />FOR OPF CE USE: '