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FOR OFFICE USE: <br /> .- <br /> ------- -- ------------------------------------------• ' PL1CATIOW FOR SANITATION PERMIT ap <br /> �mi <br /> rte <br /> ---------------------­­----- ------------- --------- (Complete in duplicate) <br /> ------------------ ----------------- ---------- ------- This Permit Expires 1 Year From Date Issued Date Issued e7___1.F'__ 7 <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 AN C TION--------- <br /> /4--l� • "" <br /> w <br /> Owner's Name G Phone <br /> :+ - <br /> Address........100•0 r ` <br /> Contractor's Name______.-_ <br /> Installation will serve: Residence Apartment ouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _)...-_ Number of bedrooms .pP'- Number of baths � <br /> ---- Lot size __.._.._cT_..,�..:..---•o-••Q-----•............... <br /> Water Supply: Public system ►[Community system ❑ Private ❑ Depth To Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand <br /> �❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ElAdobe�ardpan ❑ <br /> Previous Application Made: (If yes,dote__-/Y/.D.--------} No New Construction: Yes ❑ No g?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_________________Distance from foundation--------------------Material.._____...___ <br /> ❑ No. of compartments -------------------- <br /> Size ------- -----••-------Liquid depth_.. Capacity <br /> ----------------------- <br /> Disposal Field: Distance from nearest well__ .. <br /> ______________Distance from foundation---____-.__ __-___.Distance to nearest lot line----------------- <br /> ❑ �e-�+-4� Number of lines-----------------------------------Length of each line----- , ---------- <br /> of french----------__-• <br /> ype o filter material----------- - D - -------------- <br /> ----------- r <br /> length-------••-----•----------.-_---_--.----_-- <br /> Seepage Pit: Distance to nearest welL__ZDQ---- Distance f m f undation-----�Q..__.__.Distance to nearest lot line.____._4 .. <br /> _ <br /> Number of pits______ __________ Lining materia l._-_-Size: Diameter___l&! <br />