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-`7'/ 7 ( APPLICATION FOR SANITATION PERMIT Permit No�� (Complete in Duplicate) r — _ Date Issued ApplicaFiori`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 10____________________________ Wilkerson Manor Odile 030-CJ} Owner's Name-----------M-9-Y-4 Wilker-so11 '---- -------------- Phone------------------------------------ Address---------------------------------------------------- ---------------------------------- ------•----- eboV e ----------------------- Phone----•----------------------------- Contractor's Name--------------- ------ Installation will serve: Residence 0 Apartment House ❑ Commercial ❑ - Trailer Court ❑ Motel [_-] Other E]Number of living units:._____ Number of bedrooms _ate. Number of baths ---�C--. lot size ---7__401-77 ___ _ _________________ a Water Supply: Public:system ❑ Community system 90-00private ❑ Depth to Water Table ________ ft. ' Character of soil to a depth of 3 feet: Sand 0 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [2/Hardpan Previous Application Made: Yes R"'No ❑ New Construction: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank`or cesspool permitted if public sewer is available within 200 feet.) Septic .ank: Distance from nearest well______--_____Distan a fro foun atiorl ________ _ Ma real__________ ________________ No. of compartments- -__-_--__Size 1� _ •_____Liqui depth___ ___ __________Capaci ___ $� Disposal Field: Distance from nearest well--- A-----------D'stance from foundation____ -------------Distance to nearest !9t line---- Number ine-__Number of lines______._______ ________Length of each lin _ --�_.. Width of trench______ __.4L,' Type e of filter maM -" _____Depth of filter material____ --__-_Total length__ _____________ r Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line_________________ ❑ Number of pits-------3--------------Lining material-----------------------Size. Diameter------------------------Depth---------------------------------- Cesspool: -------------------------------Cesspool: Distance from nearest Well----------_------Distance from foundation--------------------Lining material-------------------------------------- I t- ❑ Size: Diameter------------------------------------- Depth--------------------------------- ------------------Liquid Capacity----------------------------gals. �X Privy: Distance from nearest well-----------------------------`----------------------Distance from nearest building__------------___________._-____-N-___. ❑ Distance to nearest'lot'line-� w. "'�. -`.� - +- ------- -•--•-------•--------------------------------------------------•-------------------- 1 IN Remodeling and/or repairing (clescribe):------------------------------- ----•-------------------•--•------------------------------------•---------------•---•----------•--------------.._... -----------•------------------------------------------------------;f- ----------------•----------------------•----------------------------------•-----------------------------------------•---------------------------------- -------------------------------------- --------------------•-------------------------------------•--•------.---------------------------------------...------------------------------------.-- ------------------------ ----------- -------------------------------------------------------------------•------------------------------•--•---------•--•-----------------------------------------------•---•---------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State ws, 6d rule /andegulatio of the San Joaquin Local Health District. 9(Signed) - --------- i ------ -----------------------------1.1 �------------------------ - ------(Owner and/or Contractor) + k By:... ------------------------------------ ---------------------------------------------------------------------------------(Title)---------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). Cls , FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY------------ _ .. -------DATE REVIEWED BY---------------- -- ` r - ------ ---------------- .-: - - --------------- --------- -- • - - -- ------- DATE---- - _�•--c�'-. --------••------•-- - - - - --- ------------------------- BUILDING PERMIT ISSUED ------- - DATE ----------------------•------------ Alterations and/or recommendations--------------- ------------------- ------=----------------------------------_--_---------------------------------------••----•---------------------- -----------------------------------------------------------------------------------------------------------------` ------ ----------•------ ---------------------- ----------------------------•------------------------------------------------------------------------------------------------------------------------------.-..._..--------------- FINAL INSPECTION BY:--'---- -�f-- •--•--------------- Date---------------- -` SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 30D West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California Y- ES-9-2M Revised W-2100