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q W r� v v.,. '- �+�.q•-Yr�t y.."gid'- � F" .4r ' -.. � '' - r <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ! (Complete in Duplicate) <br /> Date Issued <br /> Application is hereby made to the 1,n 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 AND LOCAT O :-- -- _ _---- -- c <br /> - •------ <br /> -------- <br /> Owner's Name----------------- -- ---------- -----'---- Phone------------------------------------ <br /> Address <br /> - - ----------------------------------------- Phone <br /> — "'` . <br /> ' ;, -- --------- <br /> Contractor's Name } -d ------ - r Phone--- ---- �. <br /> ---------- ----------- <br /> Contractor's <br /> - ---- <br /> Installation will serve: 'Residence Aparfiment House ❑ Commercial ❑ Trailer Court ❑ Motel El Other E]Number of living units: � er of bedrooms 7�_ Number of baths ___: Lot size _______. - ( - <br /> Water Supply: Public system : Community system ❑ Private ❑ Depth to Wa$er'Tat ft. I <br /> f <br /> Character of soil to a d pth of 3 feet: Sand ❑ avel ❑ Sandy Loam ❑ Clay L -: Clad❑ Adobe Hardpan ❑ <br /> Previous Application Made: Yes ❑ No New Construction: Yes.❑ No o ;. <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> ' r V <br /> Septic Tank:t Distance from nearest well______ ___Distance from foundation <br /> ?ndation_-_-.-_:_____-_____.Material_______-_ <br /> ,e. <br /> No. of compartments----- ---- -------- ------------------Liquid depth.------------- -'---------Capacity----------------- <br /> I ;,.%, �1 <br /> ------- ---- <br /> Disposal Field• Distance from nearest e! !�____ <br /> t. istance from fou ndatio ___ _ Distance to nearest lot line__ <br /> YPp each line .. <br /> r / Width of trench__=' <br /> Nurriiaer or lines__ge - <br /> _ Len, th.of <br /> T of fuer ma _�.? <br />