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FOR OFFICE USE- APPUCATION FOR SANITATION PERMIT 7s 9y v Permit No- --------------------- .... {Complete o. ---------- . lComplete In Triplicate) ............ Dati-Issued ... ........ .................... This pornilt Expires I Year From Date Issued ................... Application is hereby made to the San Joaquin Local Health District for a permit mit to construct and install the work herein described. This application is mode in complianc a with County Ordinance NO. 549 and existing Rules and Regulations: .............. JOB ADDRESS/LOCATION...... ..........B _ir.e...on_.Eas.t.-sj_de..............;..,.CENSUS TRACT ........... Mr. on. Little .. ..... .................. ...... .. .. .. ..... Phone ...... ............................. Owner's Name ................ ---------- ----------------....... ........ Lodi Address 827 Greenwood Lod --•----•---------•- ...............................City ................. ............-...... ............. 273-539 46.5.-.2-6 1.6........ ..... .... phone Contractor's Nome --------_------Ro-to...Aoot4. ,V_S.ew.e�r ................License # ....... Installation will serve: Residence(M Apartment Nouseo Co�nmerclol oTrallor Court 0 Motel.0 Other ................................ _ ..... Garbage Grinder je s �Iz ek acreage. ................. Number of living units:..-_-------- Number of bedrooms ---_-__ ........Private Water Supply: Public System and name ... ................................... ............. ............................................... Character of soil to a depth of 3 feet: Sand 13 Slit[:]' Clay 0 Peat 0 Sandy Loom 0 Clay Loom 0 Hardpan Adobe Fill M6terlol .....112..If yes,type ............... .......... (Plot plan, showing size of lot, location of -sysiwr-w In--relation-to-wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,} PACKAGE TREATMENT I I SEPTIC TANK Size.......L{J_bly._51....b �.e! ........ Liquid Depth ....4j)5............ cc 0 2 Capacity ---12N....... TypePX!P-9A-§:t.... Material. ... No. Compartments ........ 5a + 10, Distance to nearest: Well ...... ......... .Foundation ..... ................ Prop. Line ............. ........ LEACHING LINE No. of Lines l_...... ........... Length of each line....1001.•._.......... Total Length 10.01................... V Box ..nQ..... Type filter Material .... .....Depth Filter Material ......... ................ 1871 50t 101 Line ........................ Distance to nearest: Well '....................... Foundation .............. Property SEEPAGE PIT I Number: Rock Filled Yes 9) No 0 k] Depth 2-5-t.... Diameter u I epth .. 1 8 1Y... :":..... ... Water Toble 0 .... ....Rock Size .... 100 , 10 .......................... 5 Distance to nearest: Well ...........:....::.•--------•: ._........,Foundatlon .................... Prop. Line ..................... REPAIR/40DITIONIPrev. Sanitation Permit# ............................................ Dote .._.............................. 1 r ,Septic Tank (Specify Requirements) ..................... .......... ........................ ..........-................................ .......................... Disposal Field (Specify Requirements) ....... ................................. ................................................. .........:.......................... • ...................--------------- ......................................................... -----------------------....................................... --------------------------- .........................9................ ................................... I......-----------------...........6..................... ......... (Draw existing and required addition on reverse side) I hereby codify that I have prepared this application and that the work will be done in accordance %with San Joaquin -of the Son Joaquin Local Health:District}. Nome owner or, licon- County Ordinances, State Laws, and Rules and Regulations sed agents 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 manner as to become subject to Workman's Compensation tows of CalifornIM' Signed -_.. .-• ...... ........ .. ..... .. --------------•-i•-•-•---------------------...--•-• Owner ------------------__------------ litle ......Cont-rac.tor.. .................... ........... BY ---- UR- --------- (if other than owner) DEf A R TMENT USE ONLY APPLICATION ACCEPTED BY ------------------ ......... DATE 7.3 ........ ...... . BUILDING PERMIT ISSUED ... ----------------------_- .................._1....--- ::.,-.-...DAT...... ................................. ADDITIONALCOMMENTS -----------------------•---------__----__......-------•----......:......------ -----------_-•............... ..............-.......:................... ------------------ ---------------------------_------------------------- --------_r------------- ...................... .........1.............................1............... .. . ..........* ......................*...............'----------- ----------------- ...... -------------- -...................... -- ------ .................................. Final Inspection by, ...... ....................Date ---- -------- . .... 14... ....... ....... EH 13 24 1-68 V- 5M SAN JOAQUIN -LOCAL.-HEALTH DISTRICT 8/7h 3M