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APPLICATION FOR SANITATIONs PERMIT Permit No. Com Tete in Duplica ' 4 �• P P ) Date issued Application is h e y made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is de in compliance with County Ordinance No. 549. i JOB ADDRESS AND LOCATION----•....7a----/-- -------- Owner's Name------------------ •.l,_ ' ' -------------•------------------------------------------------------------------------- Phone---------------------------------- Address-------------------------------------------- --------------------Address-------------------------------------------- ---------------------------------- Contractor's Name 1--------------------------------------------------------------------------- Phone----------------------------------- a Installation will serve: Residence 9 'Apartment House ❑ Commercial ❑ Trailer Court [] Motel ❑ Other ❑ Number of living units: ___I___ Number of bedrooms*0-___ Number of baths Lot size .------ 1�_'? :_/_Y__0 ------------------- Water Supply: Public system ❑ Community system ❑ Private gL Depth to Water Table ft. t a Character of soil to a depth of 3 feet:' Sand [K Gravel ❑ Sandy Loam ❑ Clay Loam'[] Clay ❑ AdobeA Hardpan ❑ Previous Application Made: Yes ❑ No CZNew Construction: Yes-W No ❑ i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) F Septic Tank: Distance from nearest well___47v-------Distance from foundation______-!P1------_.Material_ '�--- el ' 1 No. of compartments---------�-------------Size----.3�C__ Q_?(_ar" -----Liquid depth----------¢ -------Capacity------5d4_?`\- { �f 1 ; Disposal Field: Distance from nearest well----_•.?�__0__.---Distance from foundation__�_a__________Distance to nearest lot line____'__ ___ 1 Number of lines______--�______________________Length of each line-_-7..O-167r-_!