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t FOR OFFICE USE: FOR OFFICE USE: y APPLICATION FOR SANITATION PERMIT -------- (Complete in Triplicate) Permit No.7 ---------------------- - r Date Issued_ :,/_ ..?-_79 -----------------------� 1_---- ------------- ------ This Permit Expires 1 Year From Date Issued 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 and existing Rules and Regulations: JOB ADDRESS/LOCATION__-_12401 -E.--Atkinson-Rd.p _Lodi: _Ca__95240 CENSUS TRACT____._._________ Owner's Name JerauldA, Preszl�r 369-2263 _ _ ;- ---- -- --- ---------------- -----------------------------------------------------. --- ------------- -•- Address-------------12E01--E-•---AtkWsQn_Jd•------ __---------------------------------------City--Lodi-------------------------------- --Zip-- CA--9 240----- -- Contractor's Name-------ErnieN__`_.E_ept4u---8exvic_st ..-_-__ _ _ License # _ ____--Phone -368-5105 Installation will serve: Residence 21 Apartpnent House_❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other-------------------- Number of living units:------1----- _Number of bedrooms-----_4-----Garbage Grinder---1-------Lot Size---13--acres---------------------------------------. Water Supply: Public System and;name-------P------------------ ----------- --------------------------- ------------------------------------------------------------Private Character of soil to a depth of 3 feet: : Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe ❑ Fill Material------------If yes, type_______ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLAT014: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) Ic PACKAGE TREATMENT [ I SEPTIC TANK [ ] Size___________________________________________________-__--Liquid Depth--------------------------- M Capacity_------------------Type.---------------------Material--------------------------No. Compartments--------- ---------------------•--- Distance to nearest: Well-------------------------------------------Foundation--------------------------Prop. Line_________________-__----_--- ` LEACHING LINE [ ] No. of Lines.;--------------------------- Length of each line.------------------------------Total Length ___________________________-------.--. 'D' Box------------Type Filter Material--------------------Depth Filter Material._-___.--______..___.._________.___._-....___._-----. Distance•to nearest: Well. _---- - __ _____Foundation_____ _ ______ _ ____.___-Property Line------------------------------------ V 4811 to _ 36� SEEPAGE PIT [x] Depth_A!! ___.__Diameter_3 !'___to__4Number______1_______________--___.._ Rock Filled Yes;R] No 0 Water Table Depth--------------9-5t-------------------------------- ---.Rock Size----2„ to 4" Distance to nearest: Well-----2001�feet_____________________Foundation__25�_____________Prop. Line__.12'.__-..______.__.__. REPAIR/ADDITION (Prev. Sanitation Permit#_____________________________--.____-____.___._.Date_______________-------_---------------------) SepticTank (Specify Requirements)---------------------------------------------------------------------------------------------------------------------------- ------------------ --------- DisposalField (Specify Requirements)------------- -------- ----------------------------------------------------------------------------------------------------------------------- - -----•---------------------------------------- -------- ---=--------------------------- ---------------------------------------------------------------------------- - (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Covoy Ordinances, State Laws, and Rules. and Regulations of the San Joaquin Local Health District. Home owner or licensed ageaN signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manni Am to beco subj�toork s mpensation laws of California." Signed- . .. ------------------Owner By----- - ----------- -------Title--------------------------------- (If other than owners - M -DEPARTMiENT USE ONLY APPLICATION ACCEPTED BY - - DATE. ' ------ DIVISION OF LAND NUMBER.----------------------- - - DATE--------------- ------------------ ----------- ADDITIONALCOMMENTS-------------------- ---------------------------------------- ------------------------------------------------------------------------------------------------•--- ----------------------- ----------------- ---------------------------------------------- -------------- -------------------------------------------------------- ----------------------- Final Inspection by:_________ _ ._ _ ____ ------G� Date--------------------------------------------------------- �------------- EH 13 24 SAN OOAQUIN LOCAL HEALTH DISTRICT Fas 21677 REV. 7/76 inn