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s � ' FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --- q - - - - --- - ----- ---- ------- - - - -- - . (Complete in Triplicate) Permit No.7.fc.11f. . ......... ... Date Issued.y?,_:/.3c.7 -----------------��/' 0------------ _... This Permit Expires 1 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-._12401 E. AtkinsonHd.:--Lodij..Ca_-95240__. _______CENSUS TRACT__.-----_--------------------- Owner's Name- - Jerauld Ar._Yreszlez..__.. - - _-------------- ------- ---------------------------------------------------Phone---369-2260------- _---,- Address - --------- Atkinson-Rd. ... . - ---- -----------------------------City-Lodi---------------------- --------Zip---AA-95240---- .... Contractor's -Servi-- ----- ------ - ------------------License #----------- Phone...368-5105--_--_- Installation will serve: Residence[g Apartment House 0 Commercial ❑ ,Trailer Court ❑ Motel ❑ Other -------------------------------- ------------ Number of living units:.-.....1-------- umber of bedrooms.....4-----Garbage Grinder-_1-----.Lot Size._13--acres_----- ---------------------------- Water Supply: Public System and;name......-y..---._.----...--..__.--.--------------.--------.--------------------------- Private IN Character of soil to a depth of 3jeet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe❑ Fill Material_ -"_.._-If yes,type----------------- ____----." _ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.[ NEW INSTALLATrON: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ J SEPTIC TANK [ I Size.-..-.--.--- ------------------------------..Liquid Depth--------- -.-.__-..-_..-_ Capacity-----------------Type---------------------Materlal-----------------.......No. Compartments------------------------- --------- Distance to nearest: WelL.....------------------------------- .....Foundation_..... ------------------Prop. Line_..........................� LEACHING LINE [ J No. of Lines: ..-------.Length of each lins_---.__.....................Total Length -------------.-------------------_--- -D' -._-----..------- ---'D' Box------------Type Filter Material-.-._.............Depth Filter Material----------------.------------------------- ................. p Distanceto nearest: Well.._-g.-----_--3--�-..--_.-.Foundation_- Property Line-------------_---.._...._._...-. U3 SEEPAGE PIT [3C] Depfh.l"d*_._-Diameter.3bll.to."ANumber-----1--------- ----.--------- Rock Filled Yes io No C) Water Table Depth--------------951------- - ... ........ .......Rock Size-- Zn--to--4°_........ .... --------- Distance to nearest: Well.....200^fset_ ----- ...........Foundation---25'................Prop. Line...121------------------- REPAIR/ADDITION ----__-.--- -.REPAIR/ADDITION (Prev. Sanitation Permit#----------------------------------------........_.Date.........-----..---.-_.___.---..-...._..J Septic Tank (Specify Requirements)------......—------.........._. ............................................... -----------------------------------------------....._ . DisposalField (Specify Requirements)................ . .. .............. .. ---- .. .................... ------ -------------------------------------------------------------- ... --------------------------------- ..................'--- --------------------------------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. Home owner or licensed agents signature certifies the following: "1 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 beco sub ecf to ork fis�sm enation laws of California." Signed. .- - - ----- - --- ----_.-.Owner _ //�. [ P `�'CJ By--- ---------------------------- ... ... : .... .. . ...._Title_ __ -- - (if other than owner) - f9klK~TMENT USE ONLY APPLICATION ACCEPTED BY -- - -...- . . --- ------- ---------------------- --DATE.-._ :.... .. - DIVISION OF LAND NUMBER.-------- ----- -------------------- -------------- -----------------------------------------------DATE. - - - ADDITIONAL COMMENTS-- -----------------------------------------------_--- ---------------- ----- -------------_--•--- .----------------------------------- - ------------------ ----------------------------------------.--------------------- ------------------ ------------------------------------------------------- -"----- - -------------------- - -------------------- ------- - Final Inspection by:------- - Date... ..-':. ...J ..1 ----------- EY, 13 24 SAN OOAQUIN LOCAL HEALTH DISTRICT F85 21677 REV.7/76 3M.