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`FOR OFFICE USE`: APPLICATIOW:FQR4ANITATION PERMIT Permit IN ? -7-- a o p ete�in Triplicate)----- icat } -_- ;_. _ �. - ------------------------------------------------ - Date issued _- This Permit Expires 1 Year From Date Issued ---------------------- " :0�,OZJ 3 s' -� Application is hereby made.to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance Na 549 and existing Rules and-Regulations: 4 o. Coolidge JOB ADDRESS/LOCATION ------ -- ----t�-- ------------------------ ------------------------ - ' - ------------ - -------------CENSUS TRACT -----------�-.. Owner's Name Mr FoSter ----------------------------------------- -----=-=-------------------------------Phone ----- ------ AddressSaMe-------------------------------------- --------------------------------------------- City ---------"--Stkn-------------------------------------------------_-_ Contractor's Name ala-ekar-d--'-s- -Sep -e---T-ank- do-=-----------------._.License # ._268.�5 ------- Phone ---- -- .-- 0 $.--- lnstallation will serve: Residen e [ partment House Commercial ❑Trailer Court ❑ i MOther -------------------------------------------- NUML ber of living units:------I---- Number of bedrooms ----2-___.._Garbage Grinder ------------ Lot Size ------85-1-x6_ '________'_-.-____ Water Supply: Public System and name ---------------------------------Cit-Y---------------------- --------------------------------------------Private ❑ Character of sail to a depth of 3 feet: Sand'El Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe E] Fill Material ------------ If yes,type ___________________________ (Plot plari, showing size of lot,�location of,system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLA'T'ION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) !i ' ,, i PACKAGE TREATMENT [ I SEPTIC TANK f: