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APPLICATION FOR SANITATION PERMIT Permit No. ;"'"l7��~ (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. JOB ADDRESS AND LOCATION---___--Lot-- 11 Wilkerson Manor Oe(� -C30—Oe - - - - --------------- - -- Owner's Name------------------- Wilkerson Phone------------------------__-_-- - ----------------------------------------- "-------------------------------- ------ Address.-------•---------------------------------------------------------- -------------------------- B.bOV@ --------------------- Phone Name----•---------- --------------------------------------- --------------------------------------- ---------------•---••- ---------- L Installation will serve: Residence ®'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1---- Number of bedrooms __(Number of baths J----- Lot size ______Z _' _/__ ._ ________________ Water Supply: Pubiicksystem ❑ Community system 'CJ Private ❑ Depth to Water Table ________ ft. ' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Erolkardpan ❑ Previous Application Made: Yes 0o ❑ New Construction: Yes �o ❑ 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_--.%—------Distance from foundation__ _O _Mat ri 1_-. '--D^ „--------------- No. ---- -. No. of compartments___._____R „____.__.__Size _ __�_i_ - � Liquid pth__.____+— a ________Capacity f Dis osal Field: Distance from nearest weli___--_______.._Distance from foundation____,e_P�Widfh p C � Distance to nearest lot line'".________ Number of lines___._ _. _ __-_Length of each line_______[ _ ? of trench-._.a2___ ' y Type of filter materia# !1-_ ' _-_-Depth of filter material___._�_ ____.Total length_..._f__________ _______..__________._ Seepage Pit: Distance to nearest well------------_-----------Distance from foundation--------------------Distance to nearest lot line__.----------.__. ❑ Number of.pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation-----.--------------Lining material____-________._____.____.--- ❑ Size: Diameter--------------------•--------..-------Depth-------------- -------- ---•---------------------._Liquid Capacity----------------------------gals. Privy:: Distance from nearest well.___.---------------------------------------------Distance from nearest building_______._-.--------__________________._._. ❑ Distance to nearest lot line----------T---------------- -------------------•-------------------------------- --- Remodelingand/or repairing fdescribes----------------------- = ---------------•-•----=-------------------------•- ------------------------•----------------------••--•----------------- ------------------------------------------ ------------------------------•---------•-------•---•----------------------------------•--•-------------------------------------------------•--------------------------------- Ihereby certify that I have-prepared this applicatio and that the work will be done in accordance with San Joaquin County ordinances, State I an and gul dons of th an,Joaquin Local Health District. (Signed)......... ---- -- -----•--------------- ------- ---f----------- - ---- ------------------------------------------------------------------------------------(Owner and/or Contractor) By:•---------------------------------------------------------------------- �------------------- '-------------------------------{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 APPLICATION ACCEPTED BY---------- - ------------------------------------------------- DATE-- -• -------- --------------- REVIEWEDBY------------------------------------------------- . ----------------------------------------------------•-------. DATE------ - ---- ---/ BUILDING PERMIT ISSUED------------------------- -= ---------------------------------•••---•------------------- DATE---------- --------------- -- ---------------------------- Alterations and/or recommendations:..........•------------------------------------------------------------------------------------------------------------ -•-----------------------------•--------------------------------------------- -----------------------------------------------------------------------------------•--•---•-----------------------------------------------•--- --------------------------------------------------------------•---------- ----------------------------- --------------•------------------------------------------------------------------------•------------------------------ -----------------------------------------------------------------------------------------------------------------•------------------------------ ---------•-------------------------------------------------------------•---- FINAL INSPECTION BY.---:---- -V3S Date r- 2. 7 -J 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 ES-9-2M Revised W-2100