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FOR OFFICE USE: :.k <br /> 4'R 9v-ufc <br />------------- <br />------------------------------------------ - <br /> APPLICATION 1=0R SANITATION PERMIT Permit o_ ________________________ <br /> -- ------------ <br />---------------------- ­------------------ ------------ (Complete in Duplicate) Date Issued ----------------------- <br /> --------------- --- ------------._-- This Permit Expires 1 Year From Date Issued II <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. S49. F A <br /> JOBADDRESS AND LOCATION----- ----------------------------------- - - ------------------------------------------------------------ <br /> Owner's Name Y 9 ------- Phone <br /> Address--------------- ----------- --------------------------------------•----------------------- ) <br /> Contractor's Name----------------- •-- <br /> ----------------•- •----------- - Phone..---------•---------------------- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ------.- Number of bedrooms -------- Number of baths -------- Lot size ---------------------------.---------------------_----______ <br /> Water Supply: Public system ❑ Community system ❑ Private [:] Depth to Water Table -------- ft. <br /> 4 <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan El ► <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 welf-----------------Distance from foundation-------------------Material-____-._----....____._.__-_----___--_-------._. <br /> ❑ No. of compartments------------------------Size--------------- ------Liquid depth---- ---------- ---Capacity------------•---------• I <br /> Disposal Field: Distance from nearest well_..------r..____Distance from foundation--------------------Distance•to nearest lot line_---____-_.----_- <br /> ❑ Number of lines---i------- ------Length of each line------------------------------Width-of trench--------:.--_-.__.__ <br /> Type of filter material-----___.__-------------Depth of filter material-----_----______.----- otal length------------------------------------------ <br /> ""Seepage Pit: Distance to nearest well----------------------Distance from foundation_.-___- ___ <br />