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APPLICATION FOR SANITATION PERMIT Permit No. ..__.(- _ . (Complete in Duplicate) Data Issued Applica{ion 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. 544, JOB ADDRESS AND LOCATION-------- ......1B79__ ]niyoTa ty_---• ,-- 5t!agj t-on____._------------I------------------------------------------------ Owner's Name----------------- FRANK--TKIN_----------------------------------------------- --------------------------------- - -------- Phone------HO- 45078. . .. Address----------------------------------a6Q •-•----•------------------ Contractor's Name---- -----------------------DAY---&---X1_(]H -,9_RT_,.SV-G--------------------------------------------------------• Phone.--FQ---27046-------- Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---1. Number of bedrooms -3-. Number of baths .l__ Lot size ----------5P 1---X Water Supply: Public system Z] Community system ❑ Private ❑ Depth to Water Table ---4-oft. Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [2 Hardpan ❑ Previous Application Made: Yes ❑ No [X New Construction: Yes p No ❑ Supplementary Drainage * TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wel}------------------Distance from foundation--------------------Material------------------------------------------------- No, of compartments--------------------------Size--------------------------------Liquid depth------------------------Capacity----------------------- 9xiS ting Disposal Field: Distance from nearest well--------_----_-_Distance from foundation--------------------Distance to nearest lot line_-_--__-__--_---- MiSting Number of lines----------------------------------Length of each line------------------------------Width of french----------------------------------- Type of filter material-------------------------Depth of filter material------------------ ----Total length------------------------------------------ Seepage Pit: D,stance to nearest well----- Distance from foundation--____---___ TO�Ie �- _ __.Distance to nearest lot line_ Number ofpits....1---------------Lining maferial�OCk-----------Size: Diameter - - Depth_-_-.-2-5-l ------ Cesspool: Distance from nearest well-----------------Distance from foundation------------........Lining material-_----_-.--_-_.__---__-__--._--_-_. ❑ Size. Diameter---------------------------------------Depth---------------------;•---•- - - -----: ------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ W ❑ Distance to nearest lot line--------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):--------Pl'operty.-.has-_been_-annexed_ to_..-itY___of_ Stockton -------------bi---.-S-emex_._-%eT ice.... -a---not---yet---avazla.ble. ------------------ - ---- -- -- ------------------------------------------------------------------------••---- ------------•----•-------------------------------------------------------------------••------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules Dand AY &gNIfiori of the San Joaquin Local Health District. Se_ptic_Tank Service ) (Signed)----------- ------------- --- --- -- --------------- - Contractor 1206 So. Eldorado -H_0_2-704 -----.." By:. -- --- --------Stockton*-Cafif.--- ------ - ----------------- • - - -- - {Titlel-----------Partner-•------------- ---------------- (Plot plan, showing"size of lot, location of system in relation wells, buildin , etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY liko APPLICATION ACCEPTED BY.IR....... DATE ---------------------------------------------------- REVIEWED BY------------------------------- -------------------------------------------- BUILDING -------------------------------- ------ DATE d.� BUILDING PERMIT ISSUED--------- _ P -1 DATE__..1ZF------------------------------------------------ Alterations and/or recommendafions:., ''2s4r2 --------------------------------- --------- -•----------------------------------- -----------------•-----------------------•----------------------------------- --------- -------- ------------------------------------------------•--..-..--------------------------•------ ...... -------------------------------------- --------- -- --------------------------------- ---------- ----------------------------------------- ---------------------------------•--------------------------------------- ------------------------------------------------------------------------------------------------------ --••---------------- --- -------- ------ ------------------------------------ FINAL INSPECTION .-------------. Date ` _ ` -� C� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 Arwood 12-sa