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-� 7 <br /> APPLICATION FOR SANITATION PERMIT Permit No�_._ � - <br /> (Complete in Duplicate) Date Issued_ s ~_ <br /> Application 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. <br /> JOB ADDRESS AND LOCATION--------Lot---A----- _ WilkersonManor - p�rP_e?3D--0S <br /> -------------------------------- <br /> Owner's Name-------------------- FIOYA & Wilkerson Phone-----. <br /> Address---------------------- <br /> Cantractor's Name. abOV@ ----•-------------------------------------------------------------------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence Apartment House ❑ CommercialF❑—Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: I____ Number of bedrooms _-�Number of baths ___�__ Lotisize �_ <br /> S------------- ----- --------------------- <br /> Wafer Supply: Public system ❑ Community system Private ❑ Depth to Water Table ________ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam E] Clay ❑ Adobe Vf""Ha rdpa n ❑ <br /> Previous Application Made: Yes Ry"'No ❑ New Construction: Yes No ❑ <br /> # -. <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ,-+ <br /> (No septic tank or cesspool permitted if public-sewer is available within 200 feet.) <br /> Septic T nk: Distance from nearest well -----Distaefrom unionl Q _- ----.Mat is{__ -- --- - -------------- <br /> No. of compartments--------- _-___.__Size_______r' _______ .__.Liquid epth------ "__Capacity <br /> - <br /> a <br /> Disposal,�ield: Distance from nearest well___.__`-.`--------Distance from foundation---�_D__�____.Distance to nearest lot line_______ ________ _ <br /> !/ Number of lines___._.____ Length of each line__ ___ .____ ►__ _._.Width of french------ <br /> Type of filter materia k ..._Depth of filter Material-----/e_-_t____-Total length______.____ _._.�- _______________ <br /> Seepage Pit: Distance to'nearest well'.__ '------"'""pistance from foundation.:`:_-:__....Distance to nearest lot line_________________ n <br /> i [] Number of pits----------------------Lining material----- -----------.Size: Diameter-----------------------Depth--------------------------------- rV <br /> Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material________________.____________--___ , <br /> '' ❑ Size: Diameter--------------------------------------Depth-------------------------------------------- .-Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well______________________________:i� .1_____._.__Distance from nearest building-----------------------.-• <br /> ---------------- <br /> ❑ Distance to nearest lot line---------------------------- ...... -----------•----------------------=-••--------------------------------------------------------------- <br /> Remodeling and/or repairing (describe)=---------------------------- --------- ---------••--------------•-------------------------------•------------•------------ ---------•-------------.-••- <br /> 1 <br /> --------------;-------------------- -------•-----•-------------------- -------------------------------------------------••---------------- ----•----------•----------------------------• - ----- 1 <br /> -----: I lhereb certify that Ihave----re prepared this---------------------------lica+ion an---•-------------------------------------• ---------• ------------------------------------------q--•----------- <br /> y y p p pp d that the work will be done in accordance with San Joaquin County <br /> , s, a t n <br /> an an guls of the Sd'n Joaquin Local Health District. <br /> ordinances, State <br /> (Signed)....... <br /> -- ��---------- --- <br /> {--;- = --------------{Owner and/or Contractor) <br /> --- -- ............. <br /> ) sY�-•-•--•--•--•------- ---------------------- --- --•-.---` ----- ----- -•---=•-----------'-:--------(Title)---------------------------•- --------------- ----------------- <br /> (Plot <br /> ------------ -(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.,can be placed on reverse side). <br /> R <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ---------- DATE= -------------- <br /> REVIEWED BY----------------------------- '- ----------------- ------------------------------------------ DATE---�/_ <br /> BUILDING PERMIT ISSUED------ .-- ---------•----------------•---------------------------------------• DATE----- --------------------------------------------- <br /> Alterations <br /> -- ---- ------------ <br /> Alterations and/or recommendations:4 ---- -- ----------- - ------------------------------------------------------------------•-------------•--...-----•--------•-------------- ---------- <br /> - --------------------------------------------------------------------- ----------------------------------------• --------- -•----------------------------------•-----------•-------------•---•----------------. <br /> ----------------------------------------------------------------------------------------------------------- -----------------------------------------•------------------- -----------------------I-------------------------- <br /> -----------------------•-=------------------------------------------------- - ----- -----------------------------•---------------------------------------------------------------------------------------- ---------- <br /> FINAL INSPECTION BY:---------------------•--- VIZ---- ----- -------------- Date--------------------- <br /> -------------------------------- <br /> SAN <br /> ------------------- ''=SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 614 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M : - Revised W-2100 <br />