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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete— Duplicate)in- — <br /> Date Issued ------ <br /> Applica4ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the <br /> This application is made in compliance with County Ordinance No. 549. <br /> Installation will serve: Re,_id*eJce'Ej Apartment House E] Commercial E] Trailer Court [] Motel L] Other E] <br /> Number of living units: Number of bedrooms-3--. Number of baths/---- Lof size ------ --------- <br /> Water Supply: Public system E] Community system E] Private E3-'_D_e`pth to Water Table <br /> Character of soil to a depth of 3 fee+- S d [j Gravel 171 Sandy Loam [-] ClayAoam 0-<lay El Adobe FT�lHarclpan E] <br /> Previous Application Made: Yes E] No � New Construction: Yes 0 No Ej 144e� <br /> TY"F INSTALLATION AND SPECIFICATIONS: <br /> L"o septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> pti, .1 Distance from nearest well------ ----------Distance from foundation------------- ------Material------------------------------------------------- <br /> Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> aj m <br /> Seepagq�,Vlt: Distance to nearest ...... --- 11tanc om unc1afion___X,_.,5 ...Di0qDc; to nearest IQL line------4-------- <br /> a xzro�m,�T 0, <br /> Remu6e||ng and/or repairing (de~cri6e):------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------- --``--'`-`-`-```--'`---```--``---```---`-----`----------------' <br /> ----'-------------'-----'-----'-----------'--'-------'--------''----------' <br /> ________________________________________________________________'______'__'________-_�_____ <br /> I hereby certify that I have prepared this application and that the work will be done in accordanc wi h San Joaquin County <br /> ordinances, S I"laws, and rubhAN11600 ns of the San Joaqui, cal He Ith istricf. <br /> Septic Tank Service in <br /> Stockton, Calif. <br /> By:---*-------------------- - - - - - - ------------------------------------ <br /> (Plot plan, showing s�ize of lot, location of system in relation to buildings,4etc ,*anbe plac d/on reverse side). <br /> FOR DEPARTMENT USE ONLY' <br /> Alta,ationo and/or recommendations:------ ----------------------- ----------------------------------------------------------------------------------------------- _-_______. <br /> —'--'--'-''''--''-''-'-'''---''---'--''''--''--'---''''--'''''--''''-''--''--'----------'--' <br /> �__�__���____��__���___- -____��__��_�_���_��___��___�__���_____�__�_�__��_��-_���__��������_ <br /> —'--'--'-'''---'---''-''''-''''—'''-'-'''---'---''-''''-'''--'-'—'-'---'''—'-''--'------- <br /> ---'-'-'''-'''------''-- —''--''--'''-'''--''---''-''-'-''—'''----------- <br /> �o � ^� v� � <br /> FlM/\L INSPECTION BY�.. -----. Dut�.�'~.-'� �-��-6�---------.—_-_.� <br /> SANJOAQU|NLOCALHEALTHD|STRICT <br /> /xo South American Street 3ooWest Oak St=et /vz ar"°m"," Street 614 North "C" Street <br /> St*^m"". California Lodi, California w(wn**^*. California Tracy, California <br /> .� <br /> "=-r_"" `°^46",°"O" `,.= . <br />