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FOR OFFICE USE: <br /> SANITATION PERMIT =. <br /> y - APPLICATION SUR S Permit No <br /> (Complete in Triplicate) <br /> ------ ---•--------------------------------------------- <br /> -- 1,"r `' Date Issued <br /> V?2c This Permit Expires 1 Year From Date Issued <br /> ---------------------------------- <br /> 1.. . <br /> Application is hereby made 4o the San Joaquin Local Health District for a�per mit to .construct and install the work herein <br /> described. This application tis made in compliance-'with County Ordinance No. 549 and existing Rules and Regulation s: <br /> .. a ant Pearl r. <br /> ,J --a ------- CENSUS TRACT t <br /> JOB ADDRESS/LOCATION i ---------,------------------------------------------------------- <br /> 7-- � t <br /> Owner's Name Bechth__a__ d�-_&:_Peterson ---- -"�--.- Phone 3n $ � <br /> Address ----1 Z7---W-.---Tok9 ------------------------------------tw ----- ----- ------trCity Lodi <br /> Blackard s Se--tic ark Co ; n # nea <br /> Cantractor's Name -- ----------------------------- ----------------------- ----------- ----.Lice -- : ------------ <br /> Installation will serve. Residence A artment House Commercial Trailer Court ❑ ; <br /> i ^ ' <br /> Motel ❑ Other --------------=------------`---------------- 650'X331 <br /> ' 3 li _Sot-------'----•---- <br /> Number of living units:___ _.___ Number. of bedrooms..<__---___---Garbage Grinder -_-____.__ Lot Size ____________ <br /> :;.. V <br /> Water Supply. -public System and name =-------------------41----- -------------- --•----------------- ---------------------Private KI <br /> Character of soil to a depth of 3 feet: 'Sand❑ Silt'Zj Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hatdpan ❑ Adobe-❑ Fill Material ------------ if yes,type ---------------------------- <br /> f i + <br /> f [Plot'plan, showing size of lot, location-of-system, 'wrelation to-wells, buildings, etc. must• be placed ;side.) <br /> NEW INSTALLATION: (No septic tank or seepage--pit-permitted if public sewer is available within 200,,feefi,) <br /> f � Sie_____ � -���< -------- Liquid Depth ------Z8 PACKAGE TREATMENT SEPTIC TANK ft <br /> ------- <br /> Capacity ------------------ Material CemeT1t------ No. Compartments -----2- .....•........ <br /> 1240 Ta <br /> Distance to nearest: Well -_ Q�--ff Y ---------------Foundation -- 25-f--------- Prop. Line ----.100.0.---- -- <br /> Y LEACHING LINE ] No. of Lines _____ ____________ =Length of each.line-__3f5f_t.Lp_9--- ------ Total Length ------ <br /> 'D' Box ..-------- Type Filter Material ---- 2�r-------Depth Filter Material - _1911 <br /> 'D' <br /> ' , <br /> Distance to nearest:_Well --- _-:- 0'-_-::.�Foundation..,.11�_°---- ----------- Property Lined Q4- --...-._,....---- <br /> SEEPAGE PIT [ 4'Depth .__._._ .�_ --- Diameter _____33#_____ Number ------3------- --- ------- Rock Filled Yes �] lVo IQ <br /> a:----Water`To151e Depth -------------gQ-------------------------------Rock Size --- <br /> Distance to nearest: Well .---------1. 0_x- .•'f________________Foundation ------' prop. Line .._._.9G.t'___---_-- <br /> f REPAIR/ADDITION(Prev. Sanitation Permit# ---------------------- - ------------------) i <br /> 1204x7_. se tzc__Tank-- -__--- <br /> ----- 1------------- ate ------------ <br /> Septic Tank (Specify Requirements) -- -------------------------------- <br /> a 120_'___beach-Tf na__&---- T-i-ts_._2- r X- " <br /> Disposal Field (Specify Requirements) 3 3r 33--------------------7------------- <br /> �. ' <br /> ( ` <br /> t ----- � - k _____________________ _________________________________________fir_ <br /> 1 i y _ ___ ___________________;--.-__________.._--________--___------___-______-______----______._--.__.__-----____.---____-.,--___---.____.. <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that fhe work iill�"Iii done in accordance wit San 'Joaquin <br /> County Ordinances, Stare Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed - --------- ----- ------------------------ Owner <br /> BY --------- --------------- ------------ <br /> Title ----------------------- <br /> (If other-than owner) <br /> - FOR DEPARTMENT USE ONLY <br /> r- --------DATE -J ,- - �=---------- <br /> APPLICATION ACCEPTED BY - ----------=-------------------- <br /> t, ice_ �+_ k DATE ----- --------------------------------- <br /> BUILDING PERMIT--ISSUED----------- ---------------. - ---------, - ' - = <br /> ADDITIONAL COMMENTS ----------------------- <br /> --- w- - t' <br /> ---------- <br /> --------------------------------- <br /> --------------------------------------------------------------------- <br /> - ------ ----- ---------------------------------------------------------------------------------- <br /> - ----- <br /> --`--------- ------- ----- - --- - <br /> Final Inspection b �----- ----- -- ------- ----------------Date -- --------�------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />