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FOR OFFICE USE: ' <br /> s APPLICATION. FOR SANITATION PERMIT Permlt No 7 ::Z...... <br /> _---- ---------:........................:...... iCeteplele in upineeb) <br /> : o ; <br /> D te;lssued .. �Z.... <br /> 1, ! !..._.........__..._. This Permit Expires i Year From DaNlssifed <br /> ....................... . <br /> Application is hereby made to the San Jaequin local Health District for a permit to constrsict and Install the work hereii <br /> s described. This application Is made In compliance.with County Ordinance No. 549 and existing Rules and Regulationsr <br /> JOB ADDRESS/LOCATION...:.:...........Birn.mtit...Luar e...on..East..side..............:....CENSW TRACT ......................... <br /> Owner's Name ..._................ .Mr- .. on. Little ! �' f43-;?1 ^ZZ'.. Phone ................................... <br /> ....................................... Lodi........ <br /> 82 Greenwood <br /> i, Address ....................7..............------------ •---............................. City .................................. <br /> a 6 -2616 <br /> Contractor's Name ................&oto-_23uater...Sewer...Aer�«...- .-........lianas tP ..:. 7 539.. Phone . ..5.............._... <br /> Installation will serve: ' Residence®Apartment Houser') Commercial DTrailer Court O <br /> . ' Motel 0 Other .....2.........:..:.......:.......:........ - - t` <br /> yes 4 acreage <br /> Number of living units,_..__--_-- Number of bedrooms .._.........Garbogo Grinder .---........ lot .\ <br /> Water Supply: Public System and name . .......:......................»...............: ..�......._._.................:............:........Private ... <br /> Character of soil to c depth of 3 feet: L Sand 13. Silt❑' Clay Q Peat QSandy Loom Q Clay Loom❑ <br /> FHardpan 0 Adobe® FIR Material -----!12-If Yes,'type .... <br /> (Plot plan, showing size of lot, location of. system In relation-to wells, buildings, etc. must be placed on reverse side <br /> NEW INSTALLATION: No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTI't TANK W .` Size.7;-4 ...by...5C1...b •9'•........ Liquid Depth ............. <br /> y <br /> iJ Capacity ...1Z-Q-Q_......TypeP.x:ARA t. 50V .... Material.conclset10No. Compartments � L............. <br /> I' Distance,to nearest: Well ...... ...........Foundation ................._-•- Prop. Line ............._..... <br /> LEACHING LINE ( No. of Lineal........'.............. Length of each line....�001...-•••••••••• Tocol length 1Q0!................ <br /> D' Box ..A9..... Type Filter Material ...rP.� ...---Depth Filter Material l8."........................5-r-- <br /> 101 <br /> . r- <br /> Distance to nearest: Well t...5................. Foundation .:-�......._........... Property Line ....................., <br /> ` .i: Rack Filled Yes ® No I <br /> SEEPAGE PIT )Ki Depth 255.1.............. Diameter .34n..:..... Number: --:;. 1. ..,.....--•_'-- <br /> k Water TdIble Depth ......1. 11................................Rock Size .... <br /> 1001TbY... °:...... <br /> ' <br /> : <br /> .'Distance to nearesh Well ...........I...........................Foundation 1................ Prop. Line..........._........ <br /> REPAIR/ADDITION IPrev. Sanitation Permit# ........... .......-........................ Dais _...:.-...:..............-...... <br /> k ..Septic Tank (Specify Requirements) .................................. ..........................._............._.........._.._ <br /> IDisposal Field (Specify Requirements) --•........................._...._...................................._...............................:......................... <br /> ' :................:......-........---.......__....._.---........:.........__............._...._._ .............,_........_....................._................................................... <br /> \.A <br /> . .............,.........................................................................................:....._.................................................................................. <br /> ......: <br /> �. (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Jeaqu <br /> County Ordinances, State Laws, and Rules and Regulations-of the San Jaaquln Local Healih DifMd. Home owner er Ila <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 mann <br /> as to become subject to Workman's Compensation laws of California'. <br /> Signed _.. .. .............. . ...: .. ......._....... ........................................... Owner <br /> 1��-' ...................................... Title ..,...Coatraator.........................._..........--- <br /> (if other than owner) <br /> i' R DEPA TMENT USE ONLY <br /> APPLICATION ACCEPTED BY ...................................... <br /> ... DATE -7 -•• <br /> BUILDING PERMIT ISSUED --•......... ..... ..... . .......................:44M.�,:_,......DAT ........................... ,....... <br /> ADDITIONALCOMMENTS-----...._.................•----........_...........-•----...._..........:------•----------`---.............._..................:........................ <br /> ......... ............. ---................_..•• - . ... <br /> •-----............................ .....:..-----.. ........................---•..,........ .. ........................... ....... <br /> ...... <br /> ...._................................................................................................. <br /> 1 _...-._... .. . <br /> .................... - �- <br /> •--- " <br /> final Inspection by: . ....: . -. to . <br /> Ell 13 24 1-68 Rev. 5M SAN JOAQUIN tOCAI•HEAtTH DISTRICT 8/74 3M <br />