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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued ---/L- �-_Q- Application is hereby made to the San Joaquin Local Health District for a permit toconstructand install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION------------------------ u D .Z 7. -------Wilkins-e�---��-nor----Le-t---�----/�----------�-----�--- ----------------- Owner's Name-------------- ------------- 1 Phone-------------------------------....- 1902 Pacific Ave. Address ----------•--------- ----••------------------- Contractor's Name------------------- ROt-!..RolteP------------------------- ------- -- ----------- -------- Phond1*---5...2k-1b---------- Installation will serve: Residence [$ Apartment House ❑ Commercial ❑ , Trsiler Court ❑ Motel ❑ Other ❑ Number of living units: I---- Number of bedrooms _3--- Number of baths '__1--- Lot size _____751---x...135---_-----___---. Water Supply: Public system ❑ Community system KI Private ❑ Depth to Water Table ----4gft. Character of soil to a depth of 3 feet: Sand ❑ "Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe a Hardpan ❑ Previous Application Made: Yes ❑ No FC] New Construction: Yes [j No ❑ FHA/VA: Yes FC] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 4 Septic Tank: Distance from nearest well---XX-------.Distance from foundation-I.V-----------Material--------ac----a_r-1-c-L----------------- ® No. of compartments-2-----------------------Size---51x7---x_-4-0---------Liquid depth_Afl-----------------Capacity---8-00----------- Disposal Field: Distance from nearest well---------- Distance from foundation-le-'----------.Distance to nearest lot line--_--5_R 99 Number of lines-------2-------------------------Length of each line------75-------------------Width of french------24*-------------------- Type of filter material--r_6rk-----------Depth of filter material-----18 q-_-------Total length-----15Q---------------------------- Seepage Pit: Distance to nearest well--Xx---------------Distance from foundation---.l0!-.--_--.Distance to nearest lot line---5!-----_.-. o Number of pits-----2--------------Lining material----rock-------Size: Diameter------------------331"epth----25-t--------------------- f`^ TIN Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- ❑ Size: Diamefer-3--)------------------------------_Depth------------------------------I---------------------Liquid Capacity----------------------------gals. Privy. Distance from Nearest well-------------------------------------------------Distance from nearest building-------------------------------------.-.-. ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- New Septic s stem Remodeling and/or reps€ring (describe: -- --- - -P- ------------------------------------••---------•---------•-------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 and regulations of the San Joaquin Local Health District. (Signed)---------------------------------------- O-TQ--R.0.OTER---SEW-ER---SERV-1 --------------------------------.------ - -----{Owner and/or Contractor) Owne By:------------------------------------------- -- -------�#--�O----��--- - - -------------------(rule)---------=--- r- --------- ----------- - ---- (Piot plan, showing size of lot, loc t n of system in relation'to wells, b ildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY -APPLICATION ACCEPTED BY-------- DATE Y- = `f��-------------------------- - REVIEWEDBY--------------------------------------------------- ----------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------••-------------------------------------------------------------------------------------------- DATE----------------------------------------------------------- Alterations and/or recommendations:----- --------------------------------•------------------------_._...------------------------- ------ _— - - - ---- '4-------- ---------�-------------------=--------- ---- --------- ------------- --------- ------------------------------ ----------1---------- ----------------------------------------------------- - --------------------- FINAL INSPECTION BY:.. 1 Date------------ --�-��f� ------ ------- '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 Revlsed 6-'59 F.P.Co.