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FOR OFFICE USE: <br /> ----------- ----------?-------------- ------------------ <br /> ------------------ <br /> ---------------- <br /> __________________I-.,__.--__._____-.-_--..__----- APPLICATION FOR SANITATION PERMIT Permit No. ..5;v <br />' ------------- ----------------------- ------------------- (Complete in Duplicate) <br /> -------- - - --- This Permit tEx 0ires 1 Year From Date Issued Date Issued <br /> ` Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION__ Z e -0_ <br /> --------------------------------------------------- <br /> Owner's <br /> - --------------- <br /> Owner's Name -�_ -- ----------- Phone----- --------------------- <br /> Address-----------'" Z2,9- n- _ <br /> ' ---- ------- <br /> Contractor's <br /> -----Contractor's Name___---__ _-.____.. .r.----__-- __ <br /> ------------------------------- Phone------------------------------ -- <br /> Installation will serve: Residence ❑ Apartment House p Commercial ®railer Court ❑ Motel ❑ Other [I <br /> Number of living units: Number of bedrooms _` Number of baths _-__ Lot size ---- <br /> -------------------------------- <br /> Water Supply: Public system E] Community system r�❑ Private Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: [if yes,date-----------------:•,] No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑. <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:'__ <br /> (No septic tank or cesspool permitted if public sewer is.available within 200 feet.) <br /> Septic Tank: Distance from nearest well-----------------Disiance from ,foundation___________________ Material-----_---._.---.-_ <br /> ❑ No. of compartments.---.------- ----------Size--------------------------------Liquid depth------------ ------ _--.:_Capacity pQ <br /> Disposal Field: Distance from nearest well-----.----------:-Distance-from foundation------t-.-- ... to nearest lot line._______-______- F <br /> ❑ Number of lines--------f-------------------y----,_.Length of each line--- :.l•_-r,-_-_-_----Width of trench------------------------------------ <br /> Type of filter material-------------- ____ ._ De fh-of•filter material________________ Total length.__._____----___-QS <br /> Distance to nearest well.___®- <br />