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..,k APPLICATION FOR SANITATION PERMIT Permit No.+ a'-'i.. (Complete in Duplicate) Date Issued ----/-�--�----� 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. 549. Lot -- Wilkerson Manor 04 —o3 —Y,-5nJOB ADDRESS AND LOCATION--------------------- ------_ ----------------------------------------------------- - • --------- Floyd & Wilkerson Owner's Name------------------- --- ---------------- ------ Phone---------....------------------- Address-------------------------------------------------------------------•-------------------------------------------------------------------------------••--------------------------------•---------•------------- Contractor's Name-----'...........AbOVe-------------------------------------------------------------------------------------------------------------._ Phone----------------------------------- Installation will serve: Residence O`Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [] Number of living units: ____I__ Number of bedroom's _ Number of baths ----/_ Lot size ---------_______________ Water Supply: Public I.system ❑ Community system I 400"Frivate ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [❑ Adobe�ardpan ❑ Previous Application Made: Yes o ❑ New Construction: Yes R rho ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank.or cesspool permitted if public sewer is available within 200 feet Septic nk: Distance from nearest well-----77_----_Dista e from foundation_�Q:- _______.Ma ri l ,-tet " ___--____ No. of compartments---------- -----------.Siz-- depth__- --.--- Capacity__-- --A __-- Dis osal ield: Distance from. nearest well...... -..__,--.Distance from founds ion-----��_�----Distance to nearest lot line- EVNumber of lines---------------a---_ -_-__-__Length of each line_ _0--r-&_L�-----Width of trench-------rO___ ___F Type of filter material�i.-._�ll'_Depth of filter material____ length__________ _ _ _________________ Seepage Pit: Distance to nearest well-----------------------Distance from foundation-------------------.Distance to nearest lot line____----_--___.__ Number of pits----------------------Lining material----:------------------Size: Diameter------------------------Depth--.-_--_--_____________-__------ cess❑pool: Distance from nearest well------------- Distance from foundation---_----------------Lining material------------------_--_.--____--______- r ❑ Size: Diameter--------------------------------- ----Depth----:-----------------------------------------------Liquid, Capacity----------------------------gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building------------------------------------------ ElDistance to nearest lot line------------- ----------- -------------------=------------------------ --------------------------------------------------------------------- Remodeling and/or repairing (describe):------------------------------------------------------------••-----------------------------------•--------------------------•--------------------------- -------------------------------------------------------------------------••----------------------------•• -- . 4 --•---------------------------------------------------------------•--••----------------------------------------------------------•-------------------------------------••--------------------------------------- I hereby certify that I have prepa ed this application and'that the work will be done in accordance with San Joaquin County ordinances, State aws, d r and 'reguiatio Eof the San Joaquin Local Health District. ------ --------------- --- --------- -------------- -----------------------------------------------------------------------(Owner and/or Contractor) 1 (Signed)------ BY= --------- --------------------------------------(Title)--------------------------------------------------------------- (Plot plan, showing size of lot, location of syst rri in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- - ...----- .... DATE r ~ REVIEWEDBY------------------------------------- ---- -- -------------------------------------------------------------------------------. DATE-•-•--------------------------------•----------------------- BUILDINGPERMIT ISSUED-----------------------------------------------------------------------------------------•------------ DATE------------------------------------------------------------ Alterationsand/or recommendations------------------- ------ ---------------------------------------------------------------------------•------------------------------------------------------- ----------------------------------------------------•-----------.-------•-------------------------------•---------------------------------------------------------•---------------------------------------------------------- ----------'---------------------------------------•------------------------------------------------------------------------------------------------------------------ ----•----•--------------------------------------•-- ---------------------------•-----------------------------------------•------------------- ------------------------------------------------------------ ---•-------------------------------------------•----------------------- 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 FS-4-9M ! R-1-4 W-2100