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FOR OFFICE USE: APPLICATION FOR SANITATIONr PERMIT -----•-------------- ----------------- Permit No. " _71czt•7`/ (Complete in Triplicate) > --------------------- -------------------:--------I------ This Permit Expires 1 Year From Date Issued Date Issued _� ----------77 Application is-hereby made to the Son-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 -------•-- 1.3779_-N.---We11-s---L-ane----------- -- ---------------------------CENSUS TRACT --------------........ Owner's Name ----Robert and Patricia-A.. Ross phone -369-8-34k A Tess -------: ----- 13_77.9--N." Wells'�Lane C;tY ---- Lodi- -----------=---------- - - Contractor's Name Pay-Les rce--------------License #26737---.------ Phone 46 -R78 ---------- """ � 1 ---- - _-r . Installation will serve: Residence'g Apartment House,[] Commercial:E]Twiler Court ;❑ "Motel ❑ Other -------- --------------------— ---- Ndmber of living units:---1------ Number of bedrooms -----------_Garbage-Grinder "YeB Lot Size ---- e--------------- :Water Supply: Public System and name ------------------------ --- Y" 14 - --•--••-�------------=-----------------------•-•----------------------------------Private 'Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay jj Peat❑ Sandy Loam ® Clay Loam ❑ Hardpan ❑ Adobe❑,'Fill`Material -.---_ ,.---- If yestype• � e ti(Plof plan, showing' size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side:) ,\ NEW'INSTFALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) (� PACKAGE TREATMENT [ SEPTIC TANK.[XistIng Size-""-"--"-""-- ------------------------------ Liquid Depth _--_---------------- �. Capacity -------------------- Type =----------------- Material---------------------- No. Compartments ------"---•----------- V ' Distance to nearest: Well -----------------------------F------Foundation ---------------------- Prop. Line ---------------------- LEACHING LINE [ Na! of`Lines ----------2--"--------- Length of each +line-----50---------- Total Length ----------- Nj 'D' Box 8"_ Type Filter Material --I!�Ck ""----Depth Filter hhateriol ---ig----"_-----------------------""-•- y,A. .,. Distance to ne ra est:'Wel) __ -"-""--PIUS Foundation!-QT___P� $__-__ Property Line 51----------------"--.. for SE*1'k E-P1 *] Depth ---f__ ' - D.terrneter --""""---ember ------------- -------"_ --- 'Rock Filli d Yes ] No 0 I ,. Water Table Depth' ------ -------------------------------!---- Rock Size -------------------•- ---------- Distance to nearest: Well ---------------------"-----------� - Foundation --1fl.-"-"".""""" Prop. Line ---_" ----.----. --- REPAIR/ADDITION(Prey. Sanitation Permit#.U537--------------------------- "_ Date10/Z$/63--------------) cancilled SepticTank (Specify Requirements) ------------ ------ t-------------------------------- -----------------------------------------------------'----------------------------------- t Disposal Field (Specify Requirements) --------------------------------------------- ----------------------------------------------------I-----I--------------------- - - -- -------- ----------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------ - ----------------------------- ---------------------------- ----------------------------------------------------- ---------------------------------------------------- ------------ --------------------- _ -- (Draw existing and required addition on reverse side) 1 hergby.certify thq4 I have prepared this application and that the work will be done inaccordancewith San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature ce ifies the foil : "I certify that i rt perfo ma of• r for- h this permit is issued, I shall not employ any person in such manner as`'to beco sub*e t t n law of California." Signed a ---. Owner By --- ------.- ---------- ------------------------------------------------------------ Title Owner of !1P4y-Les" Septic_ Tank Ser/ (If of er th'n owner)Perry 0. Warthan i FOR DEPARTMENT USE ONLY APPLICATION\-ACCEPTED BY - y`f�:---rY _Mx-- -f---------------------------------------------------------- DATE --•� y - --- --------------- '-�---�--="---•-- � BUILDING PERMIT ISSUED ---------------------- -------------------------------------------------------DATE ADDITIONALCOMMENTS ------------------- ------------------------------------------------------------- -----------------------------------------------------------------•----------- t ---------------------- ------------------------------- --------------- -----•---------------------------------------------------------------------------------------------------------------------- -------------------------------------- - - - -------- - - - - -------------------------------------------- -------- ------- -- Final-inspectionby: � Date ------'- s SAN JOAQUIN LOCAL, HEALTH DISTRICT L E. H. 9 1268 Rev. 5M