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I APPLICATION FOR SANITATION PERMIT Permit No. -7y /c69 (Complete in Triplicate) This Permit Expires i Year From Date Date Issued Issued J Appl.cation is hereby made to the San Joaquin local Health District for a permit to construct and install the work herein described This applicatio 'is ffade in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRE'P TX 10950 N. West Lane Lodi, Ca. CENSUS TRACT Ownerrl�4dme `I erald C. Wolf/Charles A. Sherrow Phone 36$-75i.i Address 10950 N. West Lane City Lodi, Calif. Contractor's Name Same License #E Phone Instollrtior will serve: Residence❑Apartment House❑ Commercial g]Trailer Court ❑ O Motel ❑Other _.. Number of living units: Number of bedrooms Garbage Grinder Lot Sizp Water Supply: Public System and name _ _ ._ _ __. ._. . __..Private ❑ �! Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan Adobe ❑ Fill Material If yes,type . . ... (Plnt plan, showing size of lot, location of system in relat%on to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No peptic tank or seepage pit permitted if public sewer is available within 200 feet,) P4CKAGE TREATMENT [ ] SEPTIC TANK [ ] Size . _ Liquid Depth _.....- Capacity Type Material. No. Compartments .. ..... Distance to nearest: Well . ._. .... .Foundation Prop. line LEACHING LINE [ ] No. of Lines Length of each line Total Lengtt. D' Box Type Filter Material _ . . .__Depth Filte• Material ....... Distan,e to nearest: Well __ Foundition Property Line .... SEEPAGE PIT [ j Depth Diameter Numbe- Stock Filled Yes ❑ No Water Table Depth _ __ Rock Size Distance to nearest: Well _ ._ .....Foundation Prop. Line ...... ............... REPAIR/ADDITION(Prev. Sonita•ion Permit#t _. Date ._ _._ .. _► Septic Tank (Specify Requirements) __ _ _.. ........ ....... D;sposal Field (Specify Requirements) Add. 50'...leach Lille and. one 2 X g sump .................. r (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 So r Joaquin Local Health District. Homs owner or lire"- sed agents signaiure certifies the following: "I certify that in t e performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to becomes )Oct tp Wofkmon's mpensotion laws of California." a.,n,J 1 '2 ..�.x/ dr �- Owner By title (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY � y. �' DAT. BUILDING PERMIT ISSUED DATE ADDITIONAL COMMENTS Fin,l Inspection by: �:�!'r�C,C� f Dote// -7 - 7/ SAN JOAQUI►J LOCAL HEALTH DISTRICT F. H. 9 1-'68 Rev. 5M