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�3 APPLICATION FOR SANITATION PERMIT Permit No:,�9=3- ----- (Complete in Duplicate) Date Issmd Application is.hereby made to the San Joaquin Local Health District for a hermit tooptrust and install the work herein described. This application is made in compliance with County Ordinance No. 549. f%4 1Iile viest Highway 99 on Collier Road. JOB ADDRESS AND LOCATION----------Rt-------2-__Box-- 46 ---- campo,----Calif._--_-__- - ------------------------------------------------------ Owner's Name--------------------- Clarence GOupp. Phone__9-9298- - --------------------------------- Address----- --------------------------------- ----------------Rt------2---Box---4;6-9---AC-camps]-10----Cal.i-f-------------------------------------------------------------------------- Contractor ame_ _____________ -- - - - -------- -- ---- -- s N ____ _ Installation --------- - Phone__-- -____-- ce K Apartment House E] Commercial E] Trailer Court ❑ Motel E] Other L]6er of livingR units:n__Z__ Number of bedrooms ____,Number of baths .].----- Lot size __________________________ '1, Water Supply: Public system '❑ Community system ❑ Private:] Depth to Water Table 40__ ft. Character of soil to a depth of 3 feet: Sand Gravel .E] Sand Loam'❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ®� ,. P ❑ ❑ . Y Y Y Previous Application Made: Yes ❑ No ❑ New Construction: Yes 6 No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well________________ Distance from foundation---------------------Material_________-______________________________________- ❑ No. 'of comt artments______________---------------------------Size_=------------------------------Liquid depth----------- -------'-----Capacity------------------------ Disposal ---- ------ •'-------Disposal Field: Distance from nearest well-________________Distance from foundation--------------------Distance to nearest lot line________-___.-. ❑ Number of lines-----------------------------------------Length of each line-__.----------------------------Width of trench----------------------------_-_-_-_-_-_-`- Type of filter material____________ ______Depth of filter material-----------------------Total length________________________________________-- Seepage Pit: Distance to nearest well__--__- ___ _______Distance from foundation-----3 _____._-Distance to nearest lot line____�0 Number of pits-------l-------------Liriin9 material__ Z---Raa---Size: \ Diameter-------4X4-------.Depth-----18------------- -------- -Cessp000l `x Distance from.. -rn.e.,arest well-----------------Distance from foundation---____-------------------- Linijg mat a r ial Liquid Capacity -----�--------_--- _--gals, 1_1 .1_1 Size: Dia-me>te, r_________________ --. De t�h_ __------------------------------------------- IL Privy: `Distance from nearesf Well_ ___ " y� =____-__"Dista-nce ffom nearest-build'inzg ` � --- �] Distance to nearest lot line--------------- ----------------------------------------------------------/-/1----------------/-------C--.------------- ' a �Remodel --------------------------------------- ' 7 •,. S ( _ -= ---------------- -------------es •-------------------:------------------------------------ -----------------------------------------------•--------------•------•---------------_--------------------------------------.------------------------_----------------------_------------------------------------------------ --------- -----I——---------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------- ----------------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)_ __ (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 ACCEPTEDB _--- --- �--- _ _ __.._ - TE _ REVIEWED BY == -� ----------------------------------------------------------------------------- DATE `- BUILDINGPERMIT ISSUED----'-------------------------------------------------------------------------------------------------- DATE------------------------ -- - Alterations and/or recommendations----------------------------------------- -------------------------------------------------------------------------------------------- - ----------------------- :-' --------------•---------•---------------------- ----------------------------------------------------------------------------------------------------------------- --------------- ------------------------------ -------------------------------------- FINAL INSPECTION BY:--- ---- --------<'�- ------------ Date- ---- -- 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 I , ES-9-2M 8.51 Revised W-2100'