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FOR CN ICE USE: -I.-� -�NITATION -'-I I ► G --�.i ? i� '.". , APPLICATION FOR SAPERMIT - -------------------------------------------------------- f (Complete in Triplicate) Permit,.No: �_ Z-y" - ---------------------------------------------- J� Z -7 t� --------__________________________________----------- This Permit Expires 1 Year Brom Date Issued Date Issued __""_ __.___.. ._- Application is hereby made to the San oaquin 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 ------- 1-7201__Wor�th__`�`ii_l1= R��, --Lodi-----------CENSUS TRACT ----------------------- � Owner's Name ---- Ca-- n J. Gr•unei-eh Phone 7�7-"5�-��k ---- Address -------- ---------lYr2G-----Narth__'u--I-1�'- -13-0ad--------------------------- City Z:i_-f._C�r_r;i..V------=-------------------------- Contractor's Name O_a1-T e.s errsr. to i_nrn yt s'.------------License # ----18-,1734----- Phone 7 Installation will serve: Residence ® Apartment House❑ Commercial ❑Trailer Court ;❑ y1 " Motel F-1Other _-FiP __Tiflme_.................. Number of living units:.----2----- Number of bedrooms _____:___Y Garbage Grinder ------------ Lot Size ---------------------------- S Water Supply: Public System and name -------1iv-at x' E-'e-�� ----------------------------------------------------- •---• ------- Private ❑ Character of soil to a depth of 3 feet: Sand❑,^"Silt❑ Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam ,D Hardpan E]--.Adobe ❑ Fill Material ------------ If yes,type ---------------------------- F # (Plot plan, showing siz a.-of. lo& location-9f_system in relation to wells„ buildings, etc. must beplaced on reverse side.1 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ I SEPTIC TANK:[ ] Size---- .?00_'.11a,1 0 1--------------- Liquid Depth ---------------------.----.t � Ca,pacity1.500.g'al__ Type c_onc_ret_e Material'.T n_cr�2-te No. Compartments ------2......... --•� Distance to nearest: Well ____Foundation ______________________ Prop. Line -----------------j�___ i LEACHING LINE: [ ] No. of Lines I_ ----------- Length of. each line-------10OLF-------- Total Length __7.O.O.f.___________- .__ � ti 'D' Box ---1------ Type`Filter Material3/_4�y__ ________Depth Filter Material -------------t__----.----------------- F V Distance to nearest: Well ------------------------ Foundation ______________________ Property Line -------------------- SEEPAGE] ______-_______-SEEPAGE] PIT [ ] Depth ---25ID_______ Diameter ------ Number -------2------------------- Rock Filled. Yes [2 No .CJ Water Table Depth ------------------------------------------------Rock Size ---c-0-bb-le . }� Distance to nearest: Weil ----------------------------------------Foundation -------------------- Prop. Line .................. REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date ----------------------------------1 - 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 wiih-Son�oa`qulin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- ' i sed agents signature certifies the following: j "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such mann as to become subject to Workman's Compensation laws of California." Signed __ _.--�e -fin- jclCl ' UiC�Cl, TtC. Owner Y ,�G ��'' ----------- Title -----------pr°ps �e at-------------------------------------- (If d#her than ow r] FOR .DEPAA T USE ONLY APPLICATION ACCEPTED BY _.. ----------- ------------------- ----------------------------------------------------- -. DATE 7 ; BUILDING PERMIT ISSUED --- ------------------------------------------------4------- �DATE ----------------------------------: �... ADDITIONAL COMMENTS - : - ----- - rte--�f_--------"", ,?� -------------------------------------------_: --------------- -------- ------ --- -----r-- t,4------ _---------------------``-`---------------------------------------U------------ ----------------------------- ------- ------------ I - �----U '�/ _ ---------------------------------------------------------------------------------------------------•---------- - l if1J I Final Inspection by: = - = = Date ! 1 ------------------------------------------- - - --------- --- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT I E. H. 9 1-'68 Rev, 5M,