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APPLICATION FOR SANITATION PERMIT Permit No. ........................-.. (Complete in Duplicate) 6;",- —`� ` Date Issued ----f-------�/----•--- ApplicaFion 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..._.Lot---17 Wilkerson Manor..---------------��(p�-o3a--_o2 Owner's Name--------F`lOyd- & Wilkerson _ r -- ------------------------------------------------------------ ----- Phone.---------------------------_---- Address------------------------------------•---•----- Contractor's Name above _ ----------------------------------- Phone----------------------------------- Installation will serve: =Residence Apartment House ❑ Commercial ❑ Trailer Court-0 Motel ❑ Other ❑ Number of living units: I----- Number of bedrooms —Number of baths _______t Lot size -____7Z� -_�_3__ ______________ Water Supply: Public system ❑ Community system T-"'Private ❑ Depth to Water Table -------- ft. 4 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2--"Hardpan ❑ 4,- Previous Application Made: Yesto ❑ New Construction: Yes No ❑ N TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available'within 200 feet.} Septic T k: Distance from nearest well----�'_-------Distance from foundation__- __� .__ M erial _��---------�.... No, of comportment;__________ :_..__Si _ !" -_-Liquid depth._. _a_- -____.Capacity_ __ rQ Disposal field: Distance from nearest well_-_- Distance from foundation_/Qj__.______Distance to nearest lot line""_--_.__. _� a Number of lines-------- ------ _--______Length of each line__�0_et___4 Q__.Width of trench____, ''. Type of filter materiae'- -----Depth of filter material-------/_..._Total length---------- -_ � ------�------- Seepage Pit: Distance to"nearest well------- ___- ------ from`foundation-------------------.Distance to nearest lot line------------____- ❑ Number of pits----------------------Lining material---_-- ----------------Size: Diameter------•----------------.Depth--------------------------------- n 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------------------------------------ f ❑ Distance to nearest lot-kne---------------- Remodeling and/or repairing (describe) -----------------------------------------'------------------------------------------•---------•------------------••--------------•------------- J -------------------------------------•------------------------•-------------•------------------------.•-----------------------------•---.---------•----------------------------------- ------------------------------------ ------------------------- I hereby certify that have prepared this application and #hat the work will be done in accordance with San Joaquin County ordinances, Sta. laws d rules regulations f the San Joaquin Local Health District. (Signed)------ --- -------------------- --------- ------ ------------------------------------------------------------ ----(Owner and/or Con+rac+or) By:.............................. ... -------------------------- --- -------- -----•---------- -=-----------------------(Title)------------------------------------------------------------ ,r (Plot plan, showing size of lot, location'of systemrin relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT'USE ONLY _ APPLICATION ACCEPTED BY--- ----------------------------- DATE--- ----- J REVIEWED BY DATE --`-•------------------- BUILDING PERMIT ISSUED-- ---- - DATE ------------------•----- Alterations and/or recommendations:--------------------------------=-------------------------------------------------------------------------------==-------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------=----------------------------------------------- ---------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------ z �- FINAL INSPECTION-BY:----------�""="U) _ Date -j � SY SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-4-2M ' Revised W-2100