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' FUR OFFICE USE: -- APPLICATION FOR SANITATION PER Permit No.:.. d 23 (Complete in Duplicate) / Date .Issued '3� `G? . •. ---- This Permit Ex fres 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct a d install h escrbed. This application is d n comp a e with Count Ordinance No. 549, tum �'Ifcf� /�� '4'�"'n a 7 7 y iJorth of p Road JOB ADDRESS AND LOQ'.I1UN�W__Rt•""4 Box 533; S_tocktons West rtonta a Road f . ge - off Hi Way 99 &® i Owner's Name... . --------- -------------Dvrn dine"-C'••WiCroon ,y. 5 3- Ql d ...---• ........ - --- Phone ------ 463 403 - Address » . gmd �;I -�. ---"-------•-------"---....---"------------------------------------•- ..........--- Contractor's Name -T. k� ..Rky & NTGHT Septic Tank Service �t66•+38lt1 -............................ ------------•.._..._•-----••••--•------..._.._..._-_._.---_..... Phone ----_-46*•--••-._...._._......__. Installation will serve: Res ncee ] *Apartment House ❑ Commercial ❑ Trailer Court i ❑ Motel ❑ Other ❑ Number of living units: ...... •. Number of bedrooms .... 2- Number of baths 2 ..... Lot size©______________"----.-..-. " J 7 Acrea .� Water Supply: Public system [3Community system ❑ Private P Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe 5 Hard"r n E6_41Previous Application Made: Ilf yes,dote ------) No ❑ New Construction: Yes ❑ No LF FHA/VA: Yes ❑ No 0 TYPE OF INSTALLATION AND SPECIFICATIONS: 71 (No septic tank or cesspool permitted if puk f ct sewer is a �ail�lab(e with n X00 f :t %� Septic Tank: Distance from nearest?well.----5---.-- ... Distance from odndat;on... f �---" Material-.- COnCI'C p No. of compar�`e 4ts'"---- --- ---------Size..W...x_.4!_. ..63Rquld depth 56n •-"---• Ca aci (3Z�.B r r p tY "x$60"---- r Dist osa! Field; Distance from ..ear st well__ - Distancr from foun t'on. a_-�-. --_Distance to nearest I t ine.._9 Number of lines.__."" .� Length bf each line i__.. I,.:. Width of trench -.-_ -� � -� - eptic..Rks ' �, J.79* Type of filter matena ______________________ Depth of filter material..__ r-��"- "_ -Total length ........ _.-�-��."_---"---_ Se page Pit: Distance to neareswell...................Distances•f��m�foundation.!•_.-t Dis�t^^ante to nearest lof line____.r....._ Number of pits ._..__._..._.."__:__ Lining material_ _. ...3t' Q5t �, . .............Size: Diameter...........-......--- Depth-------__..---............ Ia ,. Cesspool: Distance from nearest well .................Distance from foundationl,�_.,,-,_;-_ Lining material_...•.._.._.±_ ❑ Size: Diamet. r.-•-•- --------------------------Depth..-.._..--.----------..._._� .. - liquid Ca acit +.-capacity _.._•---•. ................gals. y' P,r;vy.: Distance from -"nearest well .................................................Distance from nearest building ❑ �l� Distance to nearest lot line--'--.-, .........w;..:_..... : _-1• g---•-----_------------- -�-•--------------------- ................................................._... .......,.r.. _ ...w ...., . - ...._- %1116% 1 Remodelinav'has serving this LdC:_." tn _ten . a" ... } been b - -i�_b--oeeT.}.s.•.!abuP iltc._:_.QYers- Ap .©xl O e::P>iros x�g -�------------- . ayov--Mm-tem;__.QC..d.r:Lha s.perty---has..berx-aV_ dd--and.. -•-- existin- s " " g -1p__ tem--int rirages ^on -nets--bounder- es y I,hereby certify that I have prepared his•a lication and that the work will be done in accordance with San Joa uin Coun t ordinances, State laws, end rules*aAn reglu fions of the San Joaquin Local Health District, q (Signed). The i�Y NIGHT apt c Tank ervid-e- -�- 5:......_s------------------- ------ - --"-A� -- a By: ......................� .... t .��. �r "" Contract (Plot plan, showing size +f lot, location of system in-- Latton wells, buildings, fc., can be placed on•-rt�ve`rse side). FOR DEPARTMENT USE ONLY e, I, APPLICATION ACCEPTED BY....�-ComC�' W!e IDAIE —� '"U- a �rM REVIEWED BY ...............:.._._.. ------_._...-..•-----•...f--------------•• DATE__ �.� +-----•... • - -----._•.----------•- BUILDING PERMIT ISSUED --------------------..... ......... ...... '� -- -- ----. ---------------------- .......................... ........... a Alterations and/Or veto mvndations-""`� DATE____________ ________ten- •--_.-- 1. trite•... ----------------------------- ............ .......................... FINAL INSPECTION BY:. .......... .................... Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 F. Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 Wast 911h Street Stockton, California L•adifCallform io y+ Manteca, Californiaf Tracy, California F. P. C O.