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J k APPLICATION FOR SANITATION PERMIT Permit No. ..� `54_ 1 Com lete in Du /I 1, I { Duplicate)P� ) 1I Date Issued ____--,1------ ------- 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. JOB ADDRESS AND LOCATION......... l pp_.- Golden Gte I • -------------------------------------------------------- -- Owner's Name------••--EC1�+Tard Chavez Jr. & Joe Hernandez Phone3 26�� I' Address-----•----------- -----------------------------------�-ane--------------------------------------•------------------------------------------------------------------------------•-------------....------- f Contractor's Name R SH NGi----------------- ------------------------- Phone---9-r2--07---•---- Installation will serve: Residence DW Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1___ Number of bedrooms :___ . Number of baths -----�•: Lot size ____6�_-___�.__1�-��----___-------------------- Water Supply: Public system.i99 Community system ❑` Private ❑ Depth;to Water Table 4'0__ ft. Character of soil to a depth of 3 feet: Sand ❑ 1#Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,[X Hardpan ❑ Previous Application Made: Yes ❑ No N] New Construction: Yes F No ❑ Suppe emeritary drainage TYPE OF INSTALLATION AND'SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation-------.------------Material------------------------------------------------- Oo�Cf ?,Q ,E, Noof compartments Size Liquid depth - Capacity Disposal Field: Distance from nearest well.. --------------Distance from foundation--------------------Distance to nearest lot line____-_.________- E�Esting Number of lines-----------------------------------Length of each line-----------------------------.Width of fre`nch----------------------------------- Type of filter material-------------------------Depth of filter material____.__.__-._--_-_--Total length_P--------------------------------____.-__ Seepage Pit: Distance to nearest well-.NaA!�--------Distance from foundation___1S___--------Distance to nearest lot line__-__..__-._____ ( •_ 51 Number of pits-----------I--------Lining Diameter-- ---------------Depth_._.�.....I-------------------- W -` Cesspool: Distance-from nearest well-------_---------Distance from foundation .----------------Lining material-_--______-__---_______-__.__---_. E30sting Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. vl Privy: Distance from nearest well----------_--------_-----------------------------Distance from nearest building-4------------------------------I- ------ Distance tb nearest lot'line------- _.___:.'""___ ------ Remodeling and/or repairing (describe);---------------------------------------------------------------------------------------------------------------------- •---------- ----- ----------------------------••-------------'------------------••---•-•-------------------------------------------------------------------•--------•-•-------------------- -------------------------------------- 1 ----------------------------------- --------------°---------------------------------------------------------------------------------------------------------------------------------------.---------------------------------- 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. f ( .S1 ned _PJB__-- SN 1 T�_�_-� __ g ) - -------------------------------------------------- {fir" irk/off Contractor) By:-- �'g ---e •• ---- -- r -- --------------------------------------(Title)-----E-131�,.i?ta�Fo r----------------------------- (Plot plan, shof lot,'location of system in relation w IIs, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYC� ------------------------------------------------------------ DATE-- ------------------------ - -- - --------- REVIEWED BY------- --------------------- � DATE- BUILDINGPERMIT ISSUED '= ----------------------------------------- ----------- ----------------------------- DATE-------- ---------------------------------_---------- ,Alterationie s and/or.recommend ations:----------------------------- - --------- --------------------------------------------------------------•- -----------------.------------------------------- --------------------•--------------•------------------------__------------------------------------------------------------------- ------------------------------------------------------------------------------------- FINAL INSPECTION BY:___"........ .... .._�- - .�- . -- -----•- ------•--•---- ate- ---------------------------------------------------- SAN ---------------------------------=--------- SAN JOAQUIN LOCAL HEALTH DISTRICT 4 130 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 t0-52 Revised W-2100 x