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APPLICATION FOR SANITATION PERMIT Permit No. � '� {Complete in Duplicate} Date Issued 'Sy _'T Applica{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. 54.9. JOB ADDRESS AND LOCATION------ Lot------------------7_________________________________Wilkerson Manor C��-- E33n�-rZ Flo d ---------------------------------- Phone------------------- Owner's Name----------------- Wilkerson--- --r '- Address---------------------------------------------------------------------------------------------------------------•-----------------------•------------------------------------------------------------------------ Above -------- -------- Phone-------------------------- Contractor's Name-----=---------- -- --- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel p Other Number of living units: _ ---- Number of bedrooms _-dn Number of baths _.�_____ Lotsize _____7----- -_-_/U'a-__ ___ - ------------------ 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 El"H�ardpan ❑ Previous Application Made: Yes erN,o ❑ New Construction: Yes No ❑ (�} TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T nk: Distance from nearesf well--------------Distance from foundation__/aVep�';h� _Mater•al_- No. of compartmersts_______-_2--- z -,/ A__„ ------Liquid --- - ---------- p Capacity--- ___- _ 1"• -----.5i -�' .----Ca aci Disposal d: Distance from nearest well__ "'____..._.Distance from foundation__��___''(__-.Distance to nearest lot line �'__ ,� Number of lines________ .. ---------------Length of each line _ -."'"- Width of french____., ___Ej� ----------- f Type of filter materi - /I'�_._Depth of filter material_.__A _aA=_____Total length________I_AL.0------------------ r Seepage Pit: Distance to nearest'well.............__ _Distance, from foundation_-_--_________._._..Distance to nearest lot line---------------- ❑ Number of pifs----------------------Lining material'=------------------Size: Diameter-----------------------Dept h--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining mate rial--__--.------------------------------ ❑ Size: Diameter------------------------ P ---Liquid Capacity----------------------------gals. �___-____Distance from nearest building _________________________ _ Privy: Distance from nearest v✓ell__________________ ____________---____ _ g-.-,----- --- - , ❑ Distance to'nearest lot line.. .._- ___."______-_ - Remodeling and/or repairing (describe):-------------------------------------------------------------------------------- --------------• --------------------------------------•------•---------- -----------------------------------------------------------------------------------------------------------.-----------------------------------------------------------------------------------------• - I hereby certify that I have prepared this application and.tha+ the work will be done in accordance with San Joaquin County ordinances,XStla . a rul an regulains of the SanJoaquin Local Health District. (Signed)---- ------ -----a- ------ . ----- ----------------------------------------------- -------------------------------------------- -----(Owner and/or Contractor) E. GBy:-------------------------------------------•------,-------- ------------------------------------------------------------------- (Title) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY----------- --------- -------------- ------------------------------------------------------- DATE------_---- --------- ---------------- DATE. Q REVIEWED BY------------------------------------ t -( =... BU{LDING PERMIT ISSUED_ '------------- DATE Alterations and/or recommendations------ ----- --- - - --------•-----------••-•--•-=•-----•--•--------•-••---_-••---•-------- --------------------------- 4 ----------------------------------- --------------------- `- -•------------------- -------------- - ---------------------•----r--------- ------------------------------------------ ------------------------•-------------------------------------- -------------------•----------------------------------------------- •:a FINALINSPECTION BY:__-------------------------- ------------------------------ Date-------:----- ------- --------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Sfree+ 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California i:r. 9-2M Revised W-2100