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V APPLICATION FOR .SANITATION`'PERI I y Q <br /> _s � ^�. Ts Per No. --- ----/------ <br /> (Complete <br /> -•(Complete in Duplicate) <br /> Date Issued d'J� 4/ <br /> Applica+,ion 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 Courntty Or��dina/Ince No. 549. <br /> JOS ADDRESS AND LOCATlO `_-- --/U `- <br /> Owner's Name--�e = ----•-- -----•-------- Phone s � I <br /> Address........ <br /> ------------------------------------------------------------- <br /> Contractor's Name Phone_ ' <br /> Installation will serve: Residence [+',Apartment- louse-❑- Commercial-❑—TrailerTCourt .❑ Motel ❑ Other ❑ <br /> Number of livingunits: __ Nu t <br /> I �mberiof bedrooms _ ._ Number of baths __ __ Lot size __//_ d__.-- 1_ _______________________ <br /> Water Supply: Public system ❑ ommuni,ty system ❑ Private Depth to Wafer Table .Z-_� ft. <br /> Character of.s�oil to a depth of 3 fee+: Sand Ej ravel ❑ Sandy Loam ❑ Cray Loam ❑ Clay ❑ Adobe [ iardpar <br /> Previous Application Made: Yes;❑ ' No;' ew�+Construction: Yes [�No ❑ y F <br /> TYPE OF INSTALLATION ANDISPECIFICAT14NS: �. j <br /> (No septic tank or cesspool permitted..+if public sewer is available wi+hin 200 feet. <br /> ., �e �.I <br /> a t- rank: Disfance,from near!st wa ll.__.____F____-_--Distance from foundation____________________Material__________-__..__.____________._____' <br /> P 1 <br /> e No. of compartments'.---------1 �-------Size-------------------------- Liquid depth--------------------------Capacity-------------- <br /> ispo al eld: Distance from neo est welt_-_ ___. _.___.Distance from foundation _____I-----------Distance to nearest lot line_______.--. <br /> . ' ^Number o'flinesx !----`-----------`---- -------Le gth of each line-------- ----------------- Width of trench <br /> t f ' <br /> Type of filter material-------_--1----I_----_-DeVh:of filter material--j------- ----------Total length-----.-----------------------=-----_-,•-- <br /> " 7 j f 1 w.r �:f,w.i.Yw�i-`"-�.w�!�-'-'.nw,f`iMr+"d�.:` <br /> Seepage Pit: Distance to nearest well_____________________ _Distance from foundation____�,5--------.Distance to nearest lot <br /> [� Number of pits-_f_ __--+ -- ---Lining material__�.Size: Diameter.____-7_��.__--.Depth......�5-----------sw <br /> Cesspool: Distance from ne �st we}I___---- �__ __Distance from foundation-- <br /> Distance material__:--__._________________________ J <br /> ❑ Size: Diameter--`1--f-------------_ ._ _.Depth-----L--------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well <br />