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1.t5�/ & )000 <br /> -=� • APPLICATION FOR SANITATION PERMIT Permit No. "' .'. <br /> (Complete in Duplicate) Date Issued__/`5�/�~ <br /> Applica}ion is hereby made i.to the San-Joaquin Cocal''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-.2 Wilkerson Manor `��� 030--17 <br /> F .o Akerson Phone----------••------------------------ <br /> Owner's Name--------------- ---�-R�.---------------•------------------------------------------------------------------ -- ---------------------------- <br /> Address---------- <br /> --------------------- - <br /> Address-----••-----=-------------------••------•---------- --------------------------------------•----------------------------------.....---------•--------------------------------------- ----------------------- <br /> Contractor's Name-----------------abov® ------- Phone.....-------------------__-- <br /> Installation will serve: Residence 11 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ___ _- Number of bedrooms ._2_._ Number of baths _ ..-_ Lot size ______7�__x_13--_________________________________ <br /> Water'Supply: Public"system ❑ Community system [3 Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe IX Hardpan ❑ <br /> ,previous Application Made: Yes ® No ❑ New Construction: Yes ® No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 204 feet.) <br /> Septic Tank: Distance from nearest well__none----.Distance from foundation—JO.—ft-__Material--------Redwood----------------------------- ----- <br /> [ No. of compartments_.__.-----------------Size-__3x9 --_________.___Liquid depth----------ft,-----.--.Capacity_800--gals <br /> Disposal Field: Distance from nearest well__nOne__ __Distance from foundation---1Q__--------Distance to nearest lot line--- --- -____ <br /> Number of lines--------Z------------------------Length of each line---W-JQ---------Width of trench--24t--_----------------------- <br /> rType of filter material.__St-_--------Depth of filter material---1$"___._______Total length_____-�2fl__________________________ <br /> Seepage Pit: Distance to nearest well__________________;__Distance from foundation--------------------Distance to nearest lot line----------------- <br /> ❑ Nuimber of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth--------- ---------------------- <br /> Cesspool: Distance from nearest well_-____._______`Distance from foundation-------------------_Lining material--------------------------- <br /> ❑ Size: Diameter--------------------------- ----------Depth--------------------- -----------------------------Liquid Capacity-.----------------------....gats. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----------------------------------------. <br /> ` Distance to nearest-lot line_________________ _ <br /> Remodelingand/or repairing (describe)-------- ----------------------- --------•--------------------------------------------------• ------------------------------------------­-­-------------- -- <br /> ------------------------------------------------- <br /> ------------------------------------------------- --------•------------------------------------•--------------•---•--•------------•-----•------------------------------------------------------------------------------------- . <br /> ------------------------- ----------------------•------••------------------------•------------------------------- 1 <br /> ---------------------------•--•------------------------------•----------------- -----------------------------------------•- -------------------------------- ------------------------•--•------------------- <br /> I hereby certify that I haves prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Stat and t eesl rar�i-d;egula ions oft San Joaquin Local Health District. <br /> (Signed)---------- ------- -------- -- (Owner and/or Contractor] <br /> By:--------------------------------*----------- ------- - -- ------------------------------------------------------------------------(Tif le)-- <br /> (Plot plan, showing size of lo , locatin of system in relafion to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-----------L.B. DATEI -------------------------------------- <br /> REVIEWEDBY-------------------------------------------------------------------------------------•---------------------------------------... DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED-------------------- ••---------------------------- DATE-----_------------------------------------------------------ <br /> Alterationsand/or recommendaf ions:-------------- ------------------•---------- - -------------------------------------------------------------------•------------------------------------------ <br /> ----------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------- ------ ---- <br /> FINAL INSPECTION BY----=--------------------v-`S�r�-----------------=----------- Date--- - ------------------�-------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Streot . 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy. California <br /> FS-9-2M Revised W-2100 <br />