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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. =. . ......_....... . . . . . . .7�.'.. . (Conplete in Triplicate) ............ ............ .......... ... Dore Issued _�.-..L::..�..t- .... This Permit Expires I Year From Date Issued Application is hereby made to the San Joaquin Local He..lth District for a permit to construct and install the work herein Betarlbed.This application is modo o plionce with Coonty Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIJN/r..S/,OLwl�Iw�-/�-101. iln?...jX_V Of /91711 RV,_ CENSUS TRACT ...............-......... ` Owner's N`aAme �' ' ....love _.Phone .................................... o _ Address _ ._......... City /�119i1/� C/.?�._._ ..................._: Contractor's Name//Kf S. �Jni%7C... .. .... .......... ..... ......_ .-License #/72d,<3__..... Phone ��G� .._... Installation will serve: Residence❑Apartment House❑ Commercial ❑Trailer Court 0 Motel 17 Other rfl i.a:!F f................... Number of living units:---. ... Number of bedrooms C^•►+ag Grinder Lot Size -s1.=�Cr- ••-•-••.....- _ Water Supply: Public Sysiem and name .. . ................................ ...... •... • . --...................................................Privatez Character of soil to o depth of 3 feet: rand q Silt❑ Clay ❑ Peat❑ Sandy Loom G Clay Loam ❑ Hcrdpan❑ Adobe❑ Fill Material . .... ...If yes,type...-..----_----- ---- - --- � (Plot p!2n, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: 1No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ J SEPTIC//TANKkj Size. jl n....1 l.$7.1!.... ..i�.---. . Liquid Depth ................. ; r Copoc`ty lEl�a,.. Type' ype Material GL/��iu��No. Compartments �..............— Distance to nearest: Well _5_L7. ................-Foundation /C?. ..........,. Prop. Line.•r__-_..._.-.•- LEACHING LINE Ld No. of Lines _..._3 . Length of each line_1452 - - Total Length .,,5?70------------ __ i 'D' Box/c.5 . Type Filter Material ICl�C�......Depth Filter Material /9.................:-_--.............. Distance to nearest: Well Foundation /G'. ... .. Property Line ..f........ .......... SEEPAGE PIT [ ; C•eptfi . .... .. _. Diameter Numbe- Rock Filled Yes ❑ No 0 Water Table Depto .- . .... .. . ...................._.........Rock Size . ..._. -_-..--.- Distance to nearest: Well _ . ...... ..... ... ........ .....Foundation . ... .. . ..... . Prop. Line REPAIR/ADDITION(Prev. fanitotion Permits _. Date ._.. .... ... .................A q! Septic Tank ;Specify Requirements) . _. . .. ..... ........I ........ ...... Disposal Field (Specify Requirements) .. (Draw existing and required odaition on reverse side) 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, Slate Lows, and Rules and Regulations of the San Joaquin Local ?iealth District.Home owner or licon- sed agents signature certifies-he following: "1 certify that in the performance of the work for which this permit is issues, I shall not employ any person in such manner as to become subject to Workmaq'i CompeniaN'on r!gws of California." Si gn r Owner (1{other than owney FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ?fu's^' DATE! BUILDING PERMIT ISSUED DATE ADDITIONAL COMMENTS