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APPLICATION FOR SANITATION PERMIT Permit No. _ f -- �"` = (Complete in Duplicate) '/ y R Date issued 41:' �-7� 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. 549. r JOB ADDRESS AND LOCATION-_------Lat_..19---------------- - Wilkerson Manor dfC�__`__04t—aZ— Owner's Name--------------- ----Floyd & Wilkerson Phone ---•-- - Address Contractor's Name--------------above -- ------------------------------------------------------•-------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence reApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I---- Number of bedrooms -_ Number of baths Lot size . -7__T_"_-K---1 _____________________ 1 Wafer Supply: Publiclsystem ❑ Community system [Private ❑ Depth to Water Table ------- ft. Character of soil to a depth of 3 feet'. Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes�No ❑ New Construction: Yes [9/No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well------- --_-Dist ce fro foundation?. ___ _____M t riai__ No. of compartments------- ------------5� r- �.,�_:---Liqui ded�pth ---- -- Capacity_ M__ Disposal 'elcl: Distance from nearest welf------ ___...!Distance from foundation---,ld-----------Distance to nearest lot lin DK Number of lines--------------OR----------_---Length of each line__- _-_- -_U Width of french...Q_!Z _ r E Type of filter material----- -------------------Depth of filter material------- �-_-Total length---------- I----------- Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line________----_____ ❑ Number of pits----------------------Lining material--------:--------------Size: Diameter-----------------------Depth-------------------------,_------ Cesspool: Distance from nearest well-----------------Distance from foundation___.___..._-_-_-.-:Lining material-----------------_--_---._.________. ElSize: Diameter- - - ------- --------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. t Privy.:,, Distance from nearest well ----------------------- ------------Distance from nearesf building------------------------------------------ n ❑ Distance to nearest lot line------ -- ---------------- f Remodeling and/or repairing (describe):--------------------------•-------•----------------- -------------------•-------------- -------- -----------------------------------------. -.--------- ----------------•---------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------- ------------------•--------------------------------------- --------------------------------------- ------------•--•-------------------------------------------= I hereby certify that have prepared this application and that the work will be done in accordance with Sart Joaquin County ordinances, Stat laws d rules nd re ulations of the San Joaquin Local Health District. ► 4 F � - (Signed)---- ---- •-- -••-------• ---- P--- - ----- -------(Owner and/or Contractor) By� = ---------------------------------- ----------------------------------------------------------------------------------(Title)------------------------------------•-•------------------------ (Plot plan, showing size of lot, location of sysiem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE t �' REVIEWED BY - - DATE _ `V------- --------- BUILDING PERMIT ISSUED.__"---------- DATE.----- -- f -------- --------------- ------ Alterations and/or recommendations:-- ---•-------------------------------------------------•----------- ------------------------------• -------•--- -----------------------•------ ------------------------------------------------- - °�. = �------------------------------------------------------------------------------------- --------------------------- -------------------------------------------------- ---------------------------------------------------------------- --- - FINAL -INSPECTION BY-------------= ----------------------------------------- 'Date---- SAN JOAQUIN LOCAL HEALTH DISTRICT 134 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 Revised W-2100