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�l 7 APPLICATION FOR SANITATION PERMIT Permit No. /=4 (Complete in Duplicate) - Date Issued _5-A-1_5 �A Applicaa-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. I Lot 1 Wilkerson Manor —o3O"S JOBAQDRESS AND LOCATION.--------------------------5..------- ------- ------------------------------------------------------------ i Owner's Name______________ Oyd & WlkerSOri - --- Phone Address----------------------------------------------------------------------------------•-------------------------------------------------- --------------------------------------------------------- aboveContractor's Name--------- --------------------------------------------------------------•--------------------------------------------------- Phone........................- - --------- Installation will serve: Residence �artment House ❑ Commercial ❑' Trailer Court ❑ Motel ❑ Other ❑ Number of living units: A___ Number of bedrooms __''Number of baths --- e- Lot size ______7 x___�3 ------------ Water Supply: Public system ❑ 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 eHardpan ❑ Previous Application Made: Yes o ❑ New Construction: Yes VNo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T nk: Distance from nearesi well___"'-.______Dista ce from foundation/0_�Material.. ______ __ `------------- 4— Disposal ____-__._- No. of compartments_._____ ---------Size. e > _Liquid epth___4_-�.___Capacity__fN-- _f �- Disposal f field: Distance from nearest well._ ---------Distance from foundation_1__�----------l]istance to nearest lot line -__. . ....... Number of lines-- .-- .. Length of each line_ Q Width of trench ____________________ e� -- Type of filter materi _ _ __Depth of filter material___________________Total length______ , ______________._ ; Seepage Pit: Distance to,nearest well _______________.___Distance from foundation--------------------Distance to nearest lot line_______________._ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Dept h--------------------------------- z Cesspool: Distance from nearest well-----------------_Qistance from foundation------------------- Lining material---------------.__.-______-___.______. ❑ Size: Diameter------ -------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. ?1:4 Privy: Distance from nearest well-_ ----------------------------------------------Distance from nearesf building------------------------------------------ -ie� ❑ Distance'to'nearest.lot`line' ------ ------------ ------------------------------------------ ----- -------------- --------------------------------------------- Remodeling -- f Remodeling and/or repairing (describe):_.------------------------------------------------------------------------•----------------•-•--------------------- ------------------------------•--------•-•----------------•----------------•----------- ---- -------- -------------------------------------------•------- - ---------------•------------._....------------------------------•----•-------------------------------•--------------------------- I hereby certify that ave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St wS," es re ulations of the San Joaquin Local Health District. d (Signed)------ --- - • ----� --------- ----- -- --- --------.`L;,R-- ---------------- ----------------------------------------________________________._____(Owner and/or Contractor) By: :------------- {Title) \ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). v 4 FOR DEPARTMENT USE ONLY _ { APPLICATION ACCEPTED BY------------- ------------ ---------------------------------------•-------------------------° DATE - ------------- REVIEWEDBY--------------------------------------- --: - ------- ------ DATE--- - �_= -�----------------------------- BUILDINGPERMIT ISSUED------------ - -------------------------------------------------------------------- DATE----- -- -----• ------ - - Alterationsand/or recommendations:------------------------------------------------------------•--------------------------------------------I------------•-------------------------•------------- ----------I------------------------- ---------------------------------------------•--------------------•------------------•-- •--------------------------•-----••------------------------------------------------------------- --------------------------------------------- --------•------ -----•-------------------------------------------------------- -----------------------------------------------••-•--•----------------------• ----------------- ---------------------------------------------- ---•------------------------------------------------------------ ------------------=--------------------------------------------------------------------------------------------------- -----•----------------------------------------------- FINAL INSPECTION BY:--------------------------1/5------"--------------------- Date-------------------' —2 7 S""`/ 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 rS-9-2M Rev#sed W-2100