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FOR OFFICE USE: r J Y Permit No. ..../. ---- L - " --------------------------- APPLICATION FOR SANITATION PERMIT --------------------------- ______ _________ _______ (Cosnplafe in Duplicate)p � Date issue --------------•------• ----------------------- This Permit Ex ires 1 Year From Date Issued _ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance_with County Ordinance No. 549, It 11 Myron Ave. Stockton JOB ADDRESS AND LOCATION-------7 .-- 3Y---------•=-----•------••-----•---------------------• --------•-•-•- Phone........n7---•-------•--------- WilliamHill-•-----••..•---•••----------------------------------------------------- Owner's Name--------------------- ---....----------•--•-- Address -�,ame----------------------------------------------------------------------------•------•------•-------------•--- Phone..HQ---63.8-41.----••- Contractor's Name. -The ---&--N•IGHT. Other ❑ ..�8p�3.C.-�'��-- 4c•----• Trailer Court [:1 - • Motel 13Installation will serve: Residence E 'Apartment House C3 Commercial ❑ Number of living units; ___ ,"_ Number of bedrooms __1.. Number of baths .---1, Lot size ._.._ _--_.. + Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. PP y y X I Hardpan ❑ Character of soil to a depth of 3 feet+ Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 5 Application Made: (if es,date-_--__"-------- --1 NoX] New Construction: Yes ❑ No V FHA/VA: Yes ❑ No ❑ Previous App' y ;, TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 20n feet.) I 7�7 �.tt.. Material R,�dy�ppd...... Septic Tank: Distance from nearest well....Kofle..Distance from foundation__._ p ty Q st 2 -•------Size �39 X-----Liquid depth-- Capacity I � No. of compartments-------------------------- -------- •t-----•--- T-"- i - .. Disposal Field: Distance from nearest well.N.One.."-•_Distance from foundation_.__. 1fl�--••Distante to nearest lot line-IT. -•-•.• p $Q- --------------Width of trench. 2 �� Number of lines- .--1,-••---��,® Length of each line__."__-._ " k Y Type of filter material-------- p-----De th of filter material ---- g-__-.-------Total length..---.._..$Q� Seepage Pit: Distance to nearest well-----_=_`In'^---- Dis an a from founds zieonR`7-�eter_. _Distance toDneepfh-- lot Vine.---------------- Seepage ::--.-.-•_: ❑ Number of pits-.t--------------- g material.t i W `-undaiii Linin material.. Cesspool• Distance from nearest well----------------- from foundation. .-.-.__-_-____"_. q 9 gals' I ------Depth- ----- ---------------- -- --------------- Size: - ------- Liquid Capacity ❑ • ------------- -- I Privy: Distance f om nearest well-------------------------- ------Distance from nearest building----------------------- --•------•---.�------------ Distance to nearest of line--------------------------- � - l Remodeling and/or repairing (describe)---------------••-- RelDi ol].t oUse.-•------- -•-- --------•---••----•------• ---•................... -•-----------------------•--•---•--- ---•------------•-----•----•--------- ----------- ------------------------------------- -•--•--------• • ---•--------- ---•-------••------- •-- - ---------------•--------------- I hereby certify that I have prepared this application and that the work 1 be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Lo 1 He 1th District. ( � Contractors The DAY & NTGHT Septia---Tank"_D�r_ c- - (Signe --•------- ....... -------- i s „.j r T. _ ``' _ ----(Title---------- ----------•--•--•------ k Is, buildings, etc., an be pace on reverse side). (Plot plan, showing size of lot, location of system in relation to OR DE ART T USE ONLY APPLICATION ACCEPTED BY I .� �. DAT ... 2 (a--7Z— :------- - -------------•----- --••----•- DATE •- REVIEWEDBY-----------•------------------- - --------------------------------- BUILDING • --- BUILDING PERMIT ISSUED__ r --•---•----------- --- -- -----------••--•--------•--- Alterations and/or recommendations-------------------------------------------------• ------------------------------ I ----..._ ---------•-------•------- ..-.-_ V ---------------- t -------------------------------------------------------- ------•----------=--- ---••-.. ..--..__.. ..-------- W- --------------------- Date--.FINAL INSPECTION BY:-- JOAQUIN LOCAL HEALTH DISTRICT 124 Sycamore Streit 205 west 9th Street 130 South American S t 300 well Oak Street Tracy,California Stockton,caufornia I Lodi,California Mant*ca,California ES 9 REVIStO 0-59 pM si-61 ATLAS