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cg <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No. _- ----<----- <br /> ,VA' 5 I (Complete in Duplicate) r 3� <br /> `.hy 15 ( P P� � Date Issued _��----�------- <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work her described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> lQ 2 EdenAVS-•-- � 1 rA)------------------------------------------------------------------------------------- <br /> JOB ADDRESS AND LOCATION____-- -- - � � r <br /> Phone--- <br /> Owner's Name------------------- Berni-e- F'au—n—o�-s----------------------------------------------------------- <br /> ------------- 2r-���'�'---- --------- <br /> ---------------------- - <br /> Address-------•-------------------------------------------3" <br /> -ID!---A-'--- y�RR?'Wi 4---$QT16_}---ITd 11--------------- ------------------- Phone----9"__96Ik 7------------- <br /> Contractor's Name-------------------------------- _ <br /> Installation will serve: Residencex$ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -1._-- Number of bedrooms2------- Number of baths -_a.--_ Lot size _----15-0 t R13S ------------------------------ <br /> Water <br /> ----------------•------ ---- <br /> Water Supply: Public system ❑ Community system ❑ Private [3 Depth to Water Table .IZ'ff. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe$$ Hardpan ❑ ` <br /> Previous Application Made: Yes ❑ No K] New Construction: Yes ® No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) <br /> Septic Tank: Distance from nearest well-5-0-1_----__--Distance from foundat.ion---10-1--------MaterialC----{'------B x'1 C�------------------ <br /> X31 -Size�k11X 61l __ Liquid_dept�n_ 2��- --------Ca aci ____GA <br /> No.No. of compartments----- - -- & p <br /> - - -------- - <br /> t <br /> Disposal Field: Distance from nearest well ----_-___Distance from foundation----_15�-----Distance to nearest lot line-_5----------- <br /> Number of lines---------------- - Length of each line-------------------------------Width of trench----_211--___----------------- <br /> Type of filter material--ITE of filter material----1$!............Total length---- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> 171 Number of pits----------------------Lining material---------------------- Size: Diameter-----------------------Depth-------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------.-_---Lining material------------------------.---_-gals- r <br /> ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity--------------------------- <br /> Privy: Distance from nearest well------_-----------------------------------------Distance from nearest building------------------------------------------ <br /> El Distance to nearest lot line-------------------- ------------------------------------------------------------------- <br /> . <br /> Remodeling and/or repairing (describe):----------New---j.CZS_ta_L1at7-Dn------------------------------------------------------------------------------------------------ <br /> -------•---------------------------------------------------------------------------------------------------------- <br /> -------- -----------------------------------------------•-----------------------•--•------------------------------- <br /> - -- --- - ------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that i have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances. State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)------Woing <br /> PA---- QT3 + k C*-----------------------0---------------------0----------------------i-----------(�`� Contractor) <br /> By:-- -- -----------------------------------------(Title)--Est-�1Qtt2r----------------------------------; <br /> -- - --------------- - -- - - - <br /> (Plot plan, size of lot, location of system relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY________________ ___ _ ____ <br /> -- ------ ----------------------------------------------------------- DATE------ 1 ----------------------- <br /> REVIEWEDBY------------------------------------------------------- ----- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED-----------------•---------- --- --------------------------------- DATE-----------------------------------------------------•------ <br /> Alterations and/or recommendations:--------- -------------- ---------------- ----------------------------------------------------------------------------------- <br /> -------- --------------------------------------------------­-------------------------------------------------------------------------------------------------- <br /> -------- ---------------------------------------------------------------------------------------------- <br /> .1 Y2 <br /> .,. L. �1�` s Date_ / T <br /> FINAL INSPECTION BY:------_ <br /> /,,--'- ----=``-- =---m _- -_---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9--2M 8-51 Revised W-2100 <br />