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/ J ------ ---- `� ----- --------- 3 � ----------- ------------ APPLICATION FOR SANITATION PERMIT Permit No.�R. -------------------- --------------------------- (Complete in Duplicate) .................... This Permit Expires 1 Year From Date Issued Date Issued �-__lam" � t Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descried. This application is made in compliance with County Ordinance No. S49. East of gaisex Road on north side OB ADDRESS-AND LOCATION Y7 _" __Box62s."Stockton;""Coale Owner's Name---------------COI a av le :Dain,....( er eley_Fad__'r x'eamcxy}------------------ Rt• �1 Bcax' f 2; 3tockro .----- Phone------------------------ --- ---------------------------- roes ---------•-•------------------------- •-------------------------------- --------------------------""_.•--••-•--------•----•-i------ Contractor's Name__"_-�e"�Y &!NIGHT Septic Tarok Service j ------- --------- --- - ------------------------------ .._ Phone -31 Installation will serve: Residence ] Apartment House Commercial 0 Trailer Court . � a��j❑ Motel ❑ Other ❑ Number of living units�`_.____ Number of bedrooms Number of baths -_..3_ Lot sizA"erage t _ ---- Water Supply: Publics stem PP Y y ❑ Communifi s stem ""-r-� JGQ.t_ { y y ❑ Private Depth to Water Table __-____ ft. Character of soil to a depth of 3 feet: S�id Gravel E] Sandy Loam ❑ Clay Loam Clay E], Adobeff Hardpan ❑ Previous Application Made: (If yes,da e-------_------------) No ❑ New Construction: Yes ❑ No FHA/VA: Yes No ❑�: TYPE OFWINSTALLATION AND SPECIFICATIONS: A, (No sep is tank or cesspool permitted if public sewer is available within 200-feet,) ta Se tic Tank: Distanc"e front.nearest well-------___-------Distance from foundation_________- Material___ .__ R• TIN[ No. of compartmenfs_ " �� -- --- -.Size--------------------------------Liquid de th a q p ------------Capacity------ -------- - Dis --- Disposal Field: Distane from nem a well tOD= �` 201 - P ..._Distance from foun __".Distance to neares line__3Q014 19`_ 1t 1 1 ` g 2 & Number of lines_,___ __-- _-__"-----_.Length of each,line_-----_------_-_ _""-__ Width of trench-..'" I Type o filter materialeP_ ZCDe th of filter material_:... g'�-,_ rr------ 'Z i ` Total length_ __. ��" �+ Linin 7mate �"l� I - r . Number of pits._ ____ once from foundation___________________Distance to nearest lot line___"- -----_--- 211it s See a e Pit. k Distan�e to nearest well �gJ�Distlal-""--".--- ." � • Size: Diameter_ . Depth ------ ------�- ------- Cesspool: kDistance from nearest weir________ _______Distance from foundationmateriali . . --- ---- ---- Lining ------------ Size: Diameter----7- --•--•--------------------- Depth--------- ----------------------------------------Liquid Capacity-----------------------I gals. Privy: Distance from nearest well �.___------ ----,.-.----Distance from ne6rrest-buildin ---- I - t,,-.; Dista to nearest lot line__ -.--_ ----------------- 4", ;! -�- ------------ mod ling and/or repairing [.demos c�ribe):""-_"--- >- ---------------------------------------- ----------------------------------------- I- ---- —PPI.!MP#r.Y----IJra jxag{.------------------- ---------.-- ---- --- ---------------- --------------------e�-------- i� ---- ----- -----------------------------------•-------------------------------------------------------- -Of 7 """"_"-_"________"" _""_-"__ �'1`heteb,•.,.certif that ! have ----------- --------- -------- �- j a y preparedghis application and that the work will be done in_-accordance with San Joaquin ount , ordinances, Sta , laws, rules and-regul`a+ions of the San Joaquin Local Health Disfrict, q Y ; (Sighed)--;' a� fjig4t; a B�aPTEI�,,YANK SAF VI�3€ ----------------------- 1 9 Fi 3841 o tractor) ---- ------------------ ------------- BY 1raE:B1iil er.,�ive•. -H - ---------- J------ ------(Title)-------•--------- ------ Plot plan, showing siie of Io'f,'I cation of s sthm in rela"tion +o 01 s, buildin ." yY�. � g , etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ DATE �� d � ---- IEWED BY ------------ - =--------------------------------------------------- DATE ----- --- -- BUILDING PERMIT ISSUED----------------"-_- -------- -------------- rF _ __ ------ -------------------------------- Alterations and/or recommendations:_ _- - n -4----------- ----"""" - -- ------` - - ----- A, S�c�----- ------------ - ---- ------ ----- ---------- ----------------------� _W R----- ^� - -------------------------- -- - --- -�'r �' -------------------- -----•----------- --------------------------- ------------------------- �74 ----- R �:�--------------- ---.------------ -- ----------------------- -------------- ----------- ------------------ ------------------------------------ --------- ----------------------- --------- ----------- -------- FI ---- - -- -- FINAL INSPECTION BY:..--- . .. .. -------- -------------------- / - ate----- ---�f�--='.1��.----- -------------------------------------- 10 11S OAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Avo. 3t0 West Oak Street 124 Sycamore Street 20i West 9th Street �^ Stockton,California Lodi,California Manteca,California Tracy, California { r.P.co. 3 _