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FOR OFFICE USE: APPLICATION n ( f C ON FOR SANITATION PERMIT (Complete in Triplicate) Permit No. _7.�/7.l�yf r. ......................... ....................._.._....__..._..... ...... This Permit Expires ] Year From Date Issued 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 _.: 229;E. Sonora:- CENSUS TRACT ' Mr. Hansen ........................................................ . .............. :::......_.. Owner's Name ..............................•--_.__.-....................._._........_._._.......:.._..._..............Phone ................_................... P. Box 437 City i Address .- Lodi i Contractor's Name ........)?oto RQoter•.Sewer-=Ser. I.......................License # --271539 ...... phone .._...465-2.616 i Installation will serve: Residence ®Apartment House❑ Commercial ❑Trailer Court j] ' Motel [3 Other _._f ....:.............................. Number of livingunits:..._.1._... Number of beds 3 no rooms ........Garbage Grinder ....... Lot Size .................. ......................... Water Supply: Public System and name ..........Calif.- Water SEr.T--••-----------.-----•---------•-------------------------------Private ❑ Character of soil toia depth of 3 feet: Sad n : . Silt❑ Clay ❑ 1 Peat❑ Sandy loam fl Cloy Loam ❑ Hardpan [] Adobe Q Fill Material ._. ........ If yes,type .................... (Plot,plan, showing size of lot, location"of system in relation to wells, buildings, etc, must be placed or reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) e PACKAGE TREATMENT [ J SEPTIC TANK[ J Size......... ........--•----•----------------------- liquid Depth _...__•-•---•--••-•-••---- Capacity Material______________________ No. Compartments ....... .............. Distance to nearest: Well _._................................Foundation ------- .............. Prop. line ...................... LEACHING LINE [ j No. of Lines ________________________ Length of each line-- ------------------- Total Length ___-__........ .............; 'D' Box ............ Type' Filter Material .............FOU...... Filter Material ................................... Distance to nearest: Well ........................ Foundation ... .............. Property Line ......._...............- SEEPAGE PIT [ 7 Depth .................... Diameter ..........------ Number --------- -_--_-..__-____.._...... Rock Filled Yes 0 No ❑ • 3 Water Table Depth ...... ..._......� Rock Size Distance to nearest-Well .................................... Foundation .................... Prop. line ............. : REPAIR/ADDITION(Prev. Sanitation'Permit-# -----------------------------•• ........ Date .................................. Septic Tank (Specify Requirements)-:..---------------- k r 0r d Disposal Field {Specify Requirements) . - •- X_1- ---------------------------------------------• --------------- .................. .............. .:_:....-----..__....-- ........................ ------------- ................. ...... ' (}Draw existing and required_addition on reverse side) I hereby certify that I have prepared this application and thatAhe work will be done in accordance with San Joaquin County Ordinances, State laws, and Rules and Regulations of the'San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: E 11I 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 laws of California,"_V' ., V Signed . ------ - -----------= ---•-- - Owner By ----------------------------- LV..! W...•—.....::.:..... � ......_.._.. Title ...-r-ontr,a�to ----------------------------------------------- (If i- f o than owner] F_ OR-DEPARTMEtiT USE ONLY APPLICATION ACCEPTEQ BY ---- ........................... DATE _../r .......�Z ....... f BUILDING PERMIT ISSUED A ... ADDITIONAL COMMENTRf•� ...._...... , -..... i ..........................................' = . ,- --•--------------- --------------------••------...:..............•.......... .............-................. ........................................ .....__. .......__._.....___...__.:........ ......Final Final Inspection by; Date ___ `- j ......... ........ ............................. ........-_ ._.---------•-----•-- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.13 241-'6$ Rev_ 5M 7I-Y,7 Z .0