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APPLICATION FOR SANITATION PERMIT Permit No. ._ (Complete in Duplicate) S Date Issued ___�0-_._ Application 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. Across from 3013 Fairmont JOB ADDRESS AND LOCATION_______9R��X____3.000.--Block- South Fairmont St. . Owner's Name------ ,j,brard-Q_-Rubio_---(Federal Const, -Tnc. wild- -r- ------------- Phone--------HO---6$51 .---- Address-------------------------------- 122 E. Church St, -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Contractor's Name------DAY--&--NIGHT---Septi-----Tank---Sex'.vice-e------------------------------------------- Phone----------------------------------- Installation will serve: Residencies Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __2,.__ Number of bedrooms _-_3.__ Number of baths _a,___. Lot size ---05,---x__100'______--- ------------------- Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table _3Q ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe WC Hardpan ❑ Previous Application Made: Yes ❑ No [X New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ HouSe move TYPE OF INSTALLATION AND SPECIFICATIONS: In (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_-I�h2ne---Distance from foundation____3-Q_1-------Material------__-CC----BT' Ck--------------- ldc No. of compartments--------2---------------Size__61!--- 3.6!!----X_Liquid depth------5 t;------------Capacity----8 0..--i__-- Disposal Field: Distance from nearest we€I--NQne.__Distance�rom foundation__2D; Distance to nearest lot line____________. f KI Number of lines--------3------------------------Length of each line----------- -- Width of trench--------24°'_____________ __-- -------------- it t Type of filter material_S��k8]i�C......Depth of filter material---�._______ Total length------ 0___________ _ _____ Seepage Pit: Distance to nearest well_R-----4 ne_Distance from foundation-----2_Q1------Distance to nearest lot line_____--.--_______ x� Number of pits---_---2------------Lining material__$UC�i--------Size: Diameter_33_"______________Dept h__------20t 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-- --- ---------------------------- ------------------------------------------------------------------------- O Remodeling and/or repairing (describe)------------------------------------------------------------------------------------------------ ----•--------------------------------------------------- Q --------------------------------------------------------------------=--------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------•----------------------------------------- -------------------------------------------------- ------- --- --- -- I 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)-------D-AY--�...NIGHT...'Sep_t_l� Tan.k----►S-ervi � --- --- J� ------------ --------(�� Contractor) , Sy:-------------------------------------------------------------------------------------- - --- - -------{�` -----------(Title)-------.-------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation wells, buildings etc., can be placed an reverse side). FOR DE ARTMENT USE ONLY APPLICATION ACCEPTED BY---------------- ------------------ - ------------------------------------ DATE--------- ---- ,�-_.' - REVIEWEDBY-------------------------------------------- ------ ----- -- ------ -------------------------- DATE------- BUILDINGPERMIT ISSUED--------------------------- - ----------- ----------- - - - ------------------------ DATE-------------------------------- - Alterat' sand/or reco mandation ' - ---------- ---------------------- ------------------------------------------------.------------------- ------ ------------ f-- -.--------- - _ - ------------•-------- ----------------------------------------- --------------------------------------------------------------------- If ' r FINAL INSPECTION BY:------------. -- ----------------------------- Date-- -�-`3 -------------------------------------------- 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 E5-9-2M . Revised 1-57 F.P.CO.