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7� <br /> APPLICATION FOR SANITATION PERMIT Permit No. - = •' <br /> [Complete in Duplicate] <br /> Date Issued y` <br /> Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. v <br /> JOB ADDRESS AND LOCATION_ Lot 18_________________________ - -Wilkerson Manor - Dd`fp OCG--0 1 <br /> - --•---------•--• - -----------------•----------- <br /> Owner's Name--------F!Oyd-A__AilkerSOin---------------------------------------------------- -------------- Phone------------------------------------ <br /> Address----------------------------k---------------------- ----- <br /> Contractor's Name----------•--A.bOXG----------------------------------------------------------------------------------------------------------------- Phone--------------------------------- <br /> Installation will serve: Residence ,Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _1____ Number of bedrooms __?Number of baths ---/-- Lot size _ __ -.± -- <br /> Water Supply: Public system 'E] Community system K__,Private ❑ Depth to Water Table -------- ft. <br /> ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe N Hardpan ❑ <br /> Previous Application Made: Yes P100"No ❑ New Construction: Yes Mo"'No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer,is available within 200 feet.) (V <br /> Septic TO: Distance from nearest well--------__-___Distance from faundatiQn___ 0.______.Materiai <br /> M-01 <br /> No. of compartments-------,'�__-----------5izel�&_f��7�:___Liquid fepth------- Capacity,, �����m <br /> Disposal F d: Distance from nearest well__.___'"-------Distance from fouridat on_-,� -�_-_-Distance to nearest lot line. ______; <br /> Number of lines___________��.-__ __,---_Len th of each line__ � �1 r ' <br /> g --�------Irl-�.f�--.Width of trench --- Lx.��---- ------------- <br /> Type <br /> - - ----- � M <br /> Type of filter materi _ ----Depth of filter material_____ _ __---------Total length__-_ tj___________________-_ <br /> Seepage Pit: Distance to nearest well______ _____________Distance from foundation_______.___________.Distance to nearest lot line----------------- h <br /> El Number of pits----------------------Lining material------`---------------Size: Diameter_ .-------------------Depth_------------------------------- X + <br /> Cesspool: Distance from nearest well----------------'Distance from foundation_----_--------------Lining material __-_-_-____---_-___-___-___________- <br /> ❑ Size: Diameter------------ ------------- ---------- Depth------------------------------------------- ------- Liquid Capacity------------------------- gals. <br /> Privy: Distance from nearest well--------------------------------------"___-_----Distance from nearest building_`Y_____ <br /> --------------------------- <br /> ❑ Distance to nearest.-lot line------------------------------------ -----------------------------•--------------------------------------------------------------------=------ <br /> Remodelingand/or repairing (describe)-----------------------------•--------- --------------•-•------------•----------------•------•---------------------•---•---•----------------------- <br /> ----------------------------------------------•--------------------•----------------•-----•----------------------------------------------------• ---------- -------------------------------•----------------------------------- <br /> -------------------•-------------------------------------------•--••--------------------------------------------•------------------------------------------------------------------•------------------------------------ <br /> I hereby certify that I have pre are this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State ws, d, ules� d re'4ulations of the San Joaquin Local Health District. <br /> Owner and/or Contractor <br /> (Signed)------ ---- - -- ---------------�. - ---------- - ---- ----- ---..:--- --- -- ( / ) <br /> j <br /> By:.....................-•--• ... ---- ------------- --------s--------------------------------------------•---•----(Title)---------------------... ------------------------------------ <br /> (Plot plan, showing size of lot, location of system Irl-relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-----------------: ------------------------------- ----------------------------------------------- DATE-------y_/;1­ <br /> ------ <br /> REVIEWED <br /> \• <br /> REVIEWEDBY--------------------------------------------- ---- ------- ------------------------------------------------------------------- DATE---- --- <br /> BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------- ------- <br /> Alterations and/or recommendations:__________ _______ _ - <br /> ---•----------•-------••-------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------•------------------------------------------------•---•-- --------------------------------------------------- <br /> FINAL <br /> -- ---------------------------------------FINAL INSPECTION BY:------ � rDate----------- � <br /> SAN <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street + <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M Revised W-2100 <br />