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IA ;i /p SANITATION PERMIT Permit No. - 3 ---•�. •--•-- �v?h' (Cm Duplic #e) / Date Issued hisplic Pion is hereby made to th S n Join uin Local Health i fora per it application is made in compliance with Cou rdinanc?e o. 549 p to construct and install fibs work herein described. JOB ADDRESS AND LOCATION...i- 1 - _ - -------- __F_...---- -_--"_"--_"-_-- ------_Z-------------•_•----_--•----_-•---------•-_---------------.---- � Owner's Name-"---._-- Address W-x_1.1- p+ - ------- - Phone--- - -- -- Contractor's Name---- __ _ ------ 3 = Phone ------------------- --------• Installation will serve: Residence 19' Apartment House ❑ Commercial ❑ Trailer Court ❑ 1__Q_0__/ Mote! ❑ Other� Number of living units:-___j____ Number of bedrooms Z.- Number of baths --�--- Lot size _--"-[-�_�}�"__ Water Supply: Public system ❑ Communit system X ---------------- Pp y' Y Y ❑ Private W Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay El Adobe' Hardpan [] Previous Application Made: Yes ❑ New Construction: Yes �J Na ❑ � TYPE OF INSTALLATION,AND, SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within feet.) Septic Tank: Distance from nearest well"_--_____Distance ,,om found tion...... ` r rs , t kI + Mat C . No, of com artments-_.--__.--------- : ,y `� ----- ""-_;,�„� PI ^�s - Size-��... ------------p7 Liquid rdepth__. t_-`T'-_ .. Capacity------ - DisposI Field: Distanco from nee,est elle_ J` ;" stance from foundationpistance to nearest lot lie Number of lines-- ------ -= ength of each dine--------- -- i "" Q - Width of trench-.-.--" "___ Type oz filter.mater YI"" r -'epth of filter ateriaL_---_-1- -- Seepage Pit: Distance to nearesfi well. Total length___"-""-.-_�_ _ _D--- _--_-..-"--- _-Distance from foundation-------------------.Di"stance to nearest lot line_"--__--_".---_-_ ❑ Number of pi#s___-i---------------Lining 1-�ater� ial---------------}------ Size: Diameter------1-----. +� Depth --------------- Cesspool; Distance fro nearest well--.-------------"Distance from foundation--------------------Lining material_------_----_---_---_ M ❑ � Size: Diameter .i -----.Depth------ -- - - ----- ---------Liquid Capacity- --------•------------~- gals. • Privy: Distance from nearest welLDistance from nearest buildingI ❑ Distance to nb arest lot line------_-- ". Remodeling and/or repairing (describe)---------- --------------------- -- --------------------------•----•------------------------ --- ----------------------- ------•------- - ------------------ - I ! hereby certify that I have prepared-this�application,and.•thaf-fhe-work:willzbe=done,in accordance with.San Joaquin County ordinances, State laws, and rules and regulations of the San Joa uin jocal Health Dis#riot. - (Signed)-------- " - -- -- -- --------- --- ------- By:.---•------------------------•---------•--------• i ---- -- -- r Contract - - -- - caner artd/o -- - - - -----------------(Title)--------- -�;!--------a-------�� Contractor) (Plot plan, showing size of lot, location of system in relation to wells, buildings,.etc., can be placed on reverse`siJe). _ 4 M.FOR`DEP' RTMENT--USE-CNLY—_ APPLICATION ACCEPTED B - REVIEWED BY------ --------- - - - DAT - -----•------•-•------------------------------- ---------------------------------------------------------------------- DATE-=-� - BUILDING PERMIT ISSUED------------ �._ Alter tions an�or rmeecomn)endations:- -�` DATE ---- -- �,} •- `: ----------- e.. --------------------- ------------ S --' "----""---- -------------------------------------- FINAL INSPECTION BY;_._----- ..-•------- ------- --------- ------ -- Date---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130-South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stock+on, California Lodi, California Manteca, California Tracy, California ES-4-21v1 10-52 Revised W-2100