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,.6-16 ? APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) �.r Date Issued-OV.- ----- - 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, Wilkerson Manor JOB ADDRESS AND LOCATION L91-1 = - ---------------------------------------------=------------- ----- ------ Owner's Name----------------- WX------------------------------------ ----------------- Phone------------------------------------ Address------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Contractor's ----------------------------------- Address-------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------- Contractor's Name 6_bO ----VB Phone ---- ---------------------------------------------------------------------------------------------- Installation will serve: Residence r Apartment House El Commercial F] Trailer Court E] +Motel ❑ Other E]Number of living units: 1.____ Number of bedrooms _Number of baths .-.�-- Lot size ______7 Water Supply: Public system ❑ Community system Pr�pllivate ❑ Depth to Water Table ________ ft_ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam``❑ Clay Loam ❑ Clay ❑ Adobe�iardpan E]'' Previous Application Made: Yes No E] New Construction: Yes &?O o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: .� (No septic tank-or cesspool permitted if public sewer is available within 200 feet.) cy Septic Tank: Distance from nearest well----- Distance from foundation A _ .! Material_ _- - ______-_- ,___/____- NO/ No. of compartments.___-___-�O---____..-.__Si __ __ 1 , Liquid depth____ ,1 '-____Capacityp �s Disposal 'eld: Distance from nearest well._----�-----._Distance from founci __-_-Distance to nearest lot line�"_r-______f`' Number of lines----- _ __Length of eachlin /ef Width of . trench______ Depth of filter material____- .-Type of filter materi ____:_Total length______-__— 16______________. Seepage Pit: Distance to nearest well_--------------------Distance from foundation----.---------------Distance to nearest lot line----------------- i ❑ Number of pits-----------------------Lining material-----------------------Size: Diameter-----------------------Depth-------------- ------ ------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---_.______---_._____________________- fi ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Z Privy:: Distance from nearest well------------------------------------------------- from nearest building---------------------- ------------------ y ❑ Distance to nearest lot line-------------------------------------------------------------------------------------------------- ----- i Remodeling and/or repairing (describe):---------------------------------------------------------------------- " -----------------------------------------------------••-------•---- -•-------•------------------------------------------------------------- -------------------•-- ----------------------------------------------- -----------------•-------------------•------------------------------------• -----------•--------------------•-------- -------------------------- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, States, and rules a d re ulation of the San Joaquin Local.Health District. r � 1 (Signed) , ---------- --- --------- ----------- - ---------------------------------------------------------------------------------------{Owner and/or Contractor) B {Title}-- S9 Iy-------------------------------------------• --- ------------- ------------------------------------------------------------ - (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 APPLICATION ACCEPTED BY---------- ----------------------------- DATE-------- ....----=-�---� - ------�-------------- REVIEWED BY DATE "'�- ---------------- --- -------------------------------------- BUILDING PERMIT ISSUED ------------------------------------------------------------- DATE------------ -------r----------------------------------- Alterations and/or recommendations---=--------------------------------------------------------------------------------------------------------------------------------------- --------------------- -•----------------------- • --•----------•--------------•-------------------------------------------•-•-----------------------------------•------•-------•--------------- -------•-•-__•------------------------- ---------- ------------------------------------•----------------------------------------------------------------•••-----------------------------------------------------------------------------------------•--•-------- -------------------------------------I-------------------------------------------------------------------------•----•---------------------------------- ----------------------------•------- -------------------------------- cf FINAL INSPECTION• BY:--=--.-.:__'-----_------------C/--��-- --------------- Date--------------5----------7--------s------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Str"f 300 West Oak Street 132 Sycamore Sfree! 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-4-2M ; Revised W-2100