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;f APPLICATION FOR SANITATION PERMIT Permit No.15t.X__7_4__ (Complete in Duplicate) Date Issue .5� d Applica-i-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. JOB ADDRESS AND LOCATION-------- --Lot--- ----------------------- -----Wilkerson--Manor---•--------------------------- ----------------------- Owner's - o3C>—t/ -------------- Owner's Name FZDya &---Wilkerson----------------------------------------------------------------------------------- Phone---------------------- -- Address = = Contractor's Name___-'--._-__-- above -- Phone------------------- ------•------ •----------------------------•----•--•------------------------------------------------------------------ ---------------- Installation will serve: }Residenc11e [�partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ lOther Number of living units: _!----- Number of bedrooms __ __ Number o{ baths __ __ Lot size ___---- J <_- -- ________________ 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 2r"'Hardpan ❑. Previous Application Made: Yes 200�o ❑ New Construction: Yes �o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: '` 1 (No septic tank' cesspool permitted if public sewer is available within 200 fee 1 W.or Septic Tank: Distance from nearest well-----_.______Dista e from foun�gion_ _____ ________M to ial_" _ __----_----. 4 No. of compartments------�'6-------__-_,Si� ___PAS4_-;--_Li uid e .- _4- A4- Capacity_ / q P -- Disposal ield: Distance from nearest well-----~--___.-_Distance from foundati n____l__i�j .___Distance to nearest lot line �________" Number of lines------ ___ ____ Length of each line____ ___ Width of french.__ _'_-_ _ Type of filter mater ----Depth of filter material______Itf___-----Total length____________Z _ Seepage'Pif: Distance to nearestlwell__-------------- ----Distanc"e from`foundation-------"` - -------Distance to nearest lot line_:____._________I ❑ Number of pits----------------------Lining material-------------------_-Size: Diameter------------------------Depth--------------------------------- 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____.________._______El ~ Distance to nearest lot line----- '- --------------- ----f-------------------------------------------•-- ------------------------------------------ -- i � Remodeling and/or repairing (describe):------ -----•-------------------------------- ----------------•----------•-•---------•- -•--...-----------------••------------•----------••--••----- 1 Ac, ----------------------_------------------------------------------------------------------------ --• -• -------------------------------------- -- ------------------------------------------------------•-----------------------------------.-------------------:------•-------------•---------------------------------------.------------•----------------------------------- Ihereby certify that have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State aws, nd r les nd Agulations of the San Joaquin Local Health District. ` (Signed)_______ ____ _ ___ ________: .__. __ __..____ --------------------------------------------------------------(Owner and/or Contractor) j�L1 t -- - - By=---------------------------------- -------- --------:--------•-------------------------------------------------- (Title) --------------------- (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 1 F. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------------------------------------------------------------------- DATE -- ------------ k REVIEWED BY - - ----------•-.----•-------------- DATE----- ------- -- ---- w BUILDING PERMIT ISSUED_...__. ---•---------- --------- DATE ` Alterations and/or.recommendations:------------------------------- • ----- ---------•--------------------------------------------------------------------••---•-------------------------- ----------------------------------------------------------------------------I-- ---------- -------------------------------------------------------------------------•------------------------•----•-------------------------- ------------------- ------------- ----------"------------------ --•------- ----------------------------------------------------------------------------------------------------------------••----------------------- L,-5 6 S-_ 27 -4:"1" FINAL INSPECTION •BY:: --------------------------------------- :: Date---------------------------- ---- 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 ES---9-2M Revised W-2100