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. APPLICATION FOR SANITATION PERMIT Permit No &... (Complete in Duplicate) Date Issue-/ �`" Applica4-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--S-----------------------------------------Wilkerson Manor--------------------------0 --------- Owner's Name---------Floyd, Wilkerson -------------------------------------------------------- --------------=--------------------- Phone-------------------------•---------- Address-----------------•-•--------------------------------------------------------- ----------------------------------------------------------•-----•-----------------------------------------------------•--------- Contractor's Name------------------Ab yip Phone-----_------------•-----------.---- Installation will serve: f Residence q] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___r__ Number of bedrooms __A,_ Number of baths I_ Lot size Water Supply: Public system ❑ Community system [Private ❑ Depth to Water Table -------- ft_. Character of soil to a depth bf 3 feet: Sand ❑ Gravel E❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes eNo ❑ New Construction: Yes 2"No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Ma a ial___:___ ________ ___ ____ 1 /Q � ----- �,.:. - Septic ank: Distance;fcom nearest well----_____-___Dista ce from foundation__..._ _� No, of compartments_.._'°---------------Size-- __ _ --Liquid epth__--_--__ _. _____Capacity___ ------ "j 'd � Disposal wield: Distance .from nearest well.....--�------Distance from found ion__/-P_-'!"_.___Distance to nearest lot line, ------------ ------------------ p __ L-__ --Number br-dines------------- ---- - Length of each line- --D- ��------Width oftrench..-_s `- -------------- f -------- Type oT filter material-_ -- --- _ De th of filter matenal___. _--_ Total length__________ _____ ______1r1_____--________ j Seepage Pit: Distance to nearest:well______________'______Distance from foundation----................Distance to nearest lot line______.______-. �+ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter_---------------------Depth--------------------------------- Cesspool: Distance from nearest well----------------- from foundation------------------- Lining material---------------------_.______________. . ❑ Size: Diameter-- -----` Depth -----------------------Liquid Capacity----------------------------gals, ^' Privy:' Distance from rearest well_----------------------------------------------Distance from nearest building------------------------------- F❑ Distance to nearest lot line--i----------------------------------------------------------------------------------- ------------------------------------- Remodelingand/or repairing (describe):---------------------------------------------------------------------------------------------------------------------------------------------.------------- ------------------------------------------------------------------------------------••---------------------------- --------------------------------•-•-------------------------------------------------------------------- ---------- ------------------------------- - = 4 ______________________________________________________________-_____--__--_--____-__.____________.-_-____.__._______.___._______-_-_-________________-______________________________._._____-_.-_____________.. I hereby certify that I have prepay this appl'cation and tha+ +he work will be done in accordance with San Joaquin County ordinances, Sfa aws`;�a andA gulations the San Joaquin Local Health District. (Signed]_.__ ___ _. _ (Owner and/or Contractor] Sy: -------------------------------------------------------------- --------------------- ---------------------------------------..(Title)------ ---------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED D BY -----------------------------------=-------- DATE------- - ---- ----------- REVIEWED BY------------------------------------ % ------------ ------- -- ---------------------------------- DATES `-_ -------------- BUILDINGPERMIT ISSUED-----------------------------------------------------------------------------------------------------. DATE---------- --------------------------------------------- Alterationsand/or recommendations:-------------•-------------------- ------------------••--------------------------••--------.-.--------•------•-•--------------------------------•--•----------- --------------------•-------------------------•------------------------------ ------------------------------------------------------------------_------------------------------•---------------------•-•-•-•------ --•-----------------------------•------------------------ --------------------------------------•----------I----------------------------------------------------------- --------------------------------------------------- r 2- FINAL INSPECTION BY---------- --------------------GS-------------------------- Date------------------- �-------- --'r zf" - 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 FS-9—?m � . Revised W-2100