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�oR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) p Permit No. --- �~ ... -7 (Co 1. !� . --------- ----------- Date Issued ........... �6 .........................I ----- This Permit Expires ] 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 - 1.4602 No. Alpine...Rd. CENSUS TRACT Lodi Owner's Name W11J.Jam Trum.bly.. Phone36F-2309 Address Same .... . City & Se tic Tank Ser. 30721 3 , 33 Contractor's Nam -. -........ �.. . ..---. "........ ................ License .....: .,.`............ Phone .::. Installation will serve: Residence In Apartment House 0 Commercial []Trailer Court 0 Motel ❑Other . ............................... Number of living units:............ Number of bedrooms .......Garbage Grinder ..... ...... Lot Size .......... ................................. Water Supply: Public System and name .............. .............................................---•...............................................Private Character of soil to a depth of 3 feet: Sand'[] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 0 Hardpan ❑ Adobe ❑ Fill Material ............ If yes,type ............... .......... . IPlot pian, showing size of lot, location of system 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 [ 3 SEPTIC TANK t I Size................................................ Liquid Depth .......................... Capacity -------------------- Type ---- ------ -----.. Material--------- -- ........ No. Compartments ...................... Distance to nearest: Well ................................----Foundation .....-............... Prop. Line ...........I......... 6 LEACHING LINE [ ] No. of Lines . .... ._. -.-- Length of each line. -- .. --.. Total Length ........................... 0 'D' Box ...... .--.. Type Filter Material ....................Depth Filter Material .........-.................................. sjJ Distance to nearest: Well ......... . .... Foundation Property Line ........................ SEEPAGE PIT ( l Depth .__ - -----.---- Diameter --------------- Number ....---..................... Rock Filled Yes ❑ No Q - Water Table Depth ....................... ........................Rock Size _-------------_- ---- Distance to nearest: Well ........................................Foundation .................... Prop. Line .... ......... REPAIR/ADDITION(Prev. Sanitation Permit+ ------- --. ------_--------_--- Date ..................................I "Q Septic Tank (Specify Requirements) -----" --------- ------------------------------------------------------------.......................................................... . Disposal Field (Specify Requirements) 709 ..--of- leach line with sump 2'wide 12' deep ---- ...--------•.................... ......... ....-----.... and 151 long .......... -- ---- -- - ------- -- ------I----------------- -----...-------------...-.....-----------.........-----....................----- (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 County Ordinances, State Laws, and Rules and Regulations of the San .Joaquin Local Health District. Homs owner or licen- 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-t9 Workman's Compensation laws of California... Signed ----------- --- -- ---- ---- -- ••------•--- Owner Title owner- g R. C �Pntl c .. .. .... -_... ........ (if other than owner) DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . ..Cr-' . - ------ DATE - BUILDING PERMIT ISSUED ---.._DATE ........ - ADDITIONAL COMMENTS .— -- --.- ------ . - .. ................... .._ - - .... ----- --- - .... .. . .... --- ---- . .... ------------ Final Inspection b �. . ©ate . ELI 13 24 1-68 I?j--v. � S i A UIN LOCAL HE DI TRI Q H S CT $/7�, 3M