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FOR OFFICE USE: t _c ---W. ......1&_-1449------ �!E_ , �,, ------------------------------------------- ------------- APPLICATION FOR SANITATION PERMIT Permit No.,;zJ_. _ ..! -------- ---- ------------------- (Complete-in Duplicate) Date Issued .......� ... This Permit Expires 1 Year From Date Issued """""""""- 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 - o. 549. ee F ' JOB ADDRESS AND LOCATION f- Q- QR —....--ZIR �� `-- f , � ` 1 7 7 Owner's Name------ --- -- --- - ------------- ----- Phone---`�.�- � - Address ---- ----••- ---------------- ---------------------------------------- Contractor's Name .1.-d --- .. -- }---- �--"----"-- Phone.` ' -iff7- P / Installation will serve: Residence [t partment House ❑ ommercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ...... Number of bedrooms- Number of baths "Lot size - /d.'".- --- -.-. ------- Water Supply: Public system ❑ Community system ❑ Private �th to Water Table ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ ,Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date_________________ _ ) No ❑ New Construction: Yes ❑ No�0'—f FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: jl No septic tank or cesspool permitted if public sewer is available within 200 feet.) r c Distance from nearest well-----------------Distance from foundation-------------------Meterial -------------------------------- ___----------- i No. of compartments----- --- -----------®Size-------------------- --•--------Liquid depth ------- ------- ---------Capacity------------------' C? D' ie Distance from nearest well_."..Distance from foundation. [ _"-"-"--Distance to nearest lot line.-. rC�------- J Deth of filter mater�al..._ ".....-Total len Number of lines---../... ............ ....Length of each Zine. Q.� : Q. Width of trench... !