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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) ��L—.,.-�,�••-••�-r ,-,�.,�,. 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. JOB ADDRESS AND LOCATION______Lot 3 Wilkerson �DB'� ---------------------------•---------------------------------------- ----------------------- ------------------------------- Owner's Name------------- Floyd &---Wi1ker9on-- ------ Phone--------------------------------- Address-----------------------•-•-•-----------------------------------------------------------------------------=----------------------------------- Contractor's Name--------------------------"c'0.me - -----. Phone----------------------------------- Installation will serve: Residence IA Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _L Number of bedrooms __Number of baths ___/___ Lot size --- Water -Water Supply: PublicI'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 Hardpan ❑ Previous Application Made: Yes 21*"'No ❑ New Construction: Yes21'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 nearest well----`__.______Distance from foundatior� --------- MateKial_ ___ _ _____________________�-------. No, of compartments_.._____a�---------Size, _- '�- Liquid depth___ _ ~____Capacity__ __, ' . Disposal Field: Distance from nearest wel[----.,_,.--------Distance from foundation---- 4__s<-___.Distance to nearest lot line___- Number of lines------------------�--________Length of each line------c_r-4_4�----Width of trench-------4__ '______..______ k { Type of filter material_ -_�_K_-Depth of filter material_._11-----____._.Total length--..-------- �__________________ Seepage Pit: Distance to nearest well_________ ____________Distance from foundation-------------.-----.Distance to nearest lot line----__________-_. ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth--------------------------------- 41 Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- El Size: Diame#er--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy:., Distance from nearest well________________________________________________Distance from nearest building_____._._____________________-________- - ❑ - Distance to nearest lot line--------= = --------------------------- -•---•---------------- ---------------------------------------------------------------------- Remodeling and/or repairing (describe):-------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------•-------------------------------------•----•----------------------------------------------- ------------•------•------------------------------ --------------------•-------------------------------------------...-.---------------------------------------------------•----------------------------------- ----------•---------- --------------------- ------ --- I hereby certify that ve prepared this a plication and that the work will be done in accordance with San Joaquin County ordinances, State anI d r ulatio s)of the San Joaquin Local Health District. (Signed)---------- ---- -------------- ---- ---------------------------- --------------------(Owner and/or Contractor) g (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 W r1PPLICATION ACCEPTED BY------------ --- --- ---------------------------------------------•--------------- DATE--------- ' per �-�~- ------------- REVIEWED BY--------------------------------------------- -------------------- ----------------------------- ----------------------------- DATE-------------------------------•- ------------------------- BUILDING ----------------- BUILDINGPERMIT ISSUED--------------------------------------- ----•---------------------------------------------- ---------- DATE------------------------------------------------------------- Alterations and/or recommendations-------------------- ---------------------------------------------------•--.-...-_-.------------------------------------------------- -------------------------- ------------------------------------------ ------------------------------------- --------------------....----------------------------------------------------------------------------------------- ------------------------------------- --------------------------------------------------------------------------------------•---------------------------- ---•----------------------------------------------------------------------------------------------------- ------------------------------------------------------------------•------ ---• --------------------------------------------------------------------------------------------------------------------------------------------- �2 FINAL INSPECTION BY:.--- ""v Date----------------- - 5----- -• ------ -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street f 32 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9--2M Revised W-2100 "a