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� 0 <br /> .: APPLICATION FOR SANITATION PERMIT Permit No. 57 <br /> (Complete in Duplicate) 5~/ -l�- <br /> Date Issue •S- <br /> Applies*ion is hereby made toTthe San Joaquin LacaI 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 b Wilkerson Manor O Nt --m30-/3 <br /> -------------------------------- - <br /> Owner's NameFl--------------- �y-a & W-11k83'-sol1--------------------------------------- Phone <br /> Address------------------------------------------------"-_-------------------------------•----------------------------------------------------•------------ ------ <br /> Contractor's Name------------------------AboveL------------------------------------------------------•------------------------------------------------ Phone----------------------------------- <br /> Installation will serve: Residence VAparfmenf House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ---I--- Number of bedrooms -.%-- Number of baths -------- Lot size -----7__��'7 -_ Z --.-- <br /> - --- -------- --- -------- <br /> Water Supply:- Public system 0 Community system �rivate ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: and ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ze"Hardpan ❑ <br /> Previous Application Made: Yes No ❑ New Construction: Yes ❑ No ❑ <br /> O <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) JJ <br /> Septic Tank: Distance from nearest well--------------Dist`�jnce f om foundation_I�.Q - Materr'all--_1 - --_---- .+�- -------_.r- <br /> No. of compartments_.._--.-A e.7 _ ---____Liquid Vdepth____ /} °+ _ <br /> Si <br /> (! Ca acct &f <br /> Dis osa Field: Distance from nearest we ..----�.-_____Distance from founda#ion-- - --�--".".Distance to nearest lot Imel <br /> p 1 , <br /> Number of lines ----- -- =�-,- ----- --------Length of each line-00-- 4e�-- ---..Width of trench.--- - --`-------------- <br /> Type of filter materif'----. _ ---Depth of filter material_-----I -----------Total length------ -- ---- -------------------- �. <br /> Seepage Pit: Distance to nearest well------------------------Distance from foundation..........T=-----.Distance to nearest lot line-_-_-__-- <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth----------------------------,----_- <br /> Cesspool: Distance from nearest well-----------------Distance from-foundation......-------------- Lining material--_.------_----.-..-.--.--__-_----- <br /> ❑ Size: Diameter------------------------------- -----Depth----------------------------------------------------Liquid Capacity------------------- --------gals. l <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------.--.-.---__ <br /> ❑ 'Distance to nearest lot lire------------------------------------------------------------------------------------"_` <br /> Remodeling and/or repairing (describe)------------------------------------------------------------------------------------------------ --------•-------------------- <br /> -------------------•------- --------•--•---•--------•-------------------•-----------•-------•-----•---------------------------"---------•-----"----•-•-----------"---------------------------------------- ------ i <br /> --------------•-----------------------=-------•--------------• ------•----------""----------------------•-----------------------------•------••---------------------•-------- -..-----------• ------------------ i <br /> -----------------•---------------------------•--------------•- ------------------------------------------------------------------------------------•---------------------------------------------•---------------.---------- <br /> I hereby certify th t I have prepared this pplication and that the work will be done in accordance with San Joaquin County <br /> ordinances, Sfa aw aid r an gulati s of the San Joaquin Local Health District. <br /> (Signed) `r "-- ------ ---------------------------------------•---------------------------•------------__------------(Owner and/or Contractor) hk <br /> By:---------------------=------•---•-------------- ---- --------------------------------------•-•-----------------------------------(Title)---------------------------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------------------------- --- --------------------- ---------------------------------------- DATE--------- -- <br /> REVIEWEDBY--------------------------------- - - DATE----- ---------------- <br /> BUILDING PERMIT ISSUED -- -- -- DATE-------- -- _ � r .- <br /> Alterationsand/or recommendations;------ --------------------•--------------------------- -------------------------------­­-------------------------------- <br /> "-------------------------•-------------------------•----------- ------------I-----------------------------------•----------------•--•-•-------------------------•---•----------------------------------------------------•--- <br /> ------------------ ----------- ---------- ------------------------------ ----------------•--•--------------------•----------------------- --------- ------------------------------------------------------------------- <br /> - (/S� ----•---- ----- ---y------------------------------ <br /> FINAL INSPECTION 'BY:_::_------------------------•-•---------•--- <br /> ---------------- --- Date---------------•--- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-4-2M ' Revised W-MD <br />