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FOR OFFICE USE: APPLICATION FOR SANITATION P' IT .. .. ------- -- -- o (Complete in Triplicate) Permit No: .__�S� 9/ Date Issued This Permit Expires 1 Year From Date Issued - yy� � Application is hereby made to the San Joaquin Local klealth 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 9-x"9. O- ahant--Fd--------------------------------------------------------------CENSUS TRACT -.----------------- Owner's Name .0het'leg--- ._-c3si.1QT'--------------- -------------'-------- -----•---------------- -------- ------Phoned.-,209.-.482373` Address 9290_Tiahant---R -----------------_---------------------------'------------------ City -Lodi. ------- - ------------ ----------- Contractor's Name Cal Weste2`a-Zanitatinar-_Inc __...:___..License # ------------ -------------Phonel_-916-4921039 Installation will serve: Residence N Apartment House'❑ Commercial ❑Trailer Court Motel ❑Other-------------_..'- ... Number of living units:---1-----_ Number of bedrooms -----3----Garbage Grinder ------------ Lot Size .-------------------------....._......_._.- ` Water Supply: Public System and name ----------------------------------------_----------------._._..._._......_..__...___. Private Ex Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam 'i,Harcipan ❑ 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 INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,! iFACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size..._ ------7[0.0¢;- ---_----- ------------ Liquid Depth ---52�....____.,_._ Capacity _11'00----..= Typepr4a-Cast- Material__G*nCY'ete No. Compartments ...a.......... ..._ 9 Distance to j nearest: Well ....1001_._....._.....__.__Foundation 10.11---------- Prop. Line .10!.............. O LEACHING LINE [ ] No. of Lines _..3------------------ Length of each Iine..401 .___-_- -__.__ Total Length _1120 ____......._. 'D' Box-,1------- Type Filter Material -NOT-----------Depth Filter Material -----------___________________.......__-_ Q i Distance to nearest: Well .10QL-__.----- Foundation 1101.._....__..__ Property Line -_201._.. SEEPAGE PIT [ ] Depth 2x[--- ------ _ Diameter ---;5Vt---- Number _3.........._._____: Rock Filled Yes [g No ❑ Water Table Depth _--- ----------._--------------.__-----------Rock Size -----3!...to,_6w'----- 'r r. / - / Distance to nearest: Well /.elf:_.._.....____.________.Foundation __._P.__....____ Prop. Line /Q----............ REPAIR/ADDITION(Prev. Sanitation Permit# --------.------- -------__._.------------- Date --------------------.-._---_----1 L Septic Tank (Specify Requirements) --------------------------------------- -------------------------------- ---------------------------------------------------- Disposal --- Disposal Field (Specify Requirements) ---------------------------------------------------------------------------------- ......------------------------------ ------------------------ ----. --- -------------------------------------------------------------------------------------------------------'--._------------------------------------------------------------_. (Draw existing and required addition on reverse side) I hereby certify that 1 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 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 to Workman's n laws of California." I P Signed --------------------- --- Owner By - s -9Ps - -n ai-ati_ons..Iae:�.._.... -------- -------- ' - ' - Tir18 . ookkeeer - - - -------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- - ' - = - - - - --------------------------------------- DATE ------..... ` BUILDING PERMIT ISSUED ----------- ___. ...___ -----------._ __.___.;_.__ _�_. DATE ADDITIONAL COMMENTS _�Qi? _�Z3_' -� r /+cc..- mfr'_G2 _ Z_ c_____.-__ ------ ------------------ . ----------- -- -------- -- ---------------------------------------------' - ------------ v ----------------------- ---------------'-------------- ------------------ --------- Final Inspection by: ----------- ------- -0-_-0 -------------- 1-------------------- -- ---' - Date -5.. .�c ._.-... - SAN JOAQUIN LOCAL HEALTH DISTRICT C u 0 1 'LD D.... CEA F�