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... 3 Permit No. ------ APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued I, lication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. AA This'appkcation is made in compliance with County Or 'nance . 549. k f� JOB ADDRESS AND LOCATION---------�. --y-- ---- t ------•'-----"------""------------• ------ Owner s Name--------------- - -- - ------ -•---- -- ----------- ------------ --------- ----- -------------- Phone----------------------------------- Address---------------------- 1 ------------------------------------------------- Contractor's Name----------------- Phone = -- - ------------------- Installation will serve: Residence Apartment House E] Commercial ❑ Trailer Count E] lv e ❑ Other ❑' Number of living units: _-_�__ Nurriber of bedroom--- Number of aths /A2Let size ------____ ____________________ Community: system ElPrivate Depth to Water Table __ ___ ft. Water Supply: Public system ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe +''F�ardpan ❑ Previous Application Made: Yes ❑ No �ew.Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS:,,_ _— t- (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-lrM"1.�.8__Distance from foundation__�.b___ _.Material_____ ____ __ __ ____ ____ ________...._______-- No. of compartments-----_- ----._---Size__ -- •-- __-- -- O.- q E? "� F !� _ -Liq, -de th__. __l`?---:.------Capacity-_-/_;—4, Disposal field: Distance from nearest well-41 ---?-"Distance from foundatipp _I-0_-.___---Distance to nearest lot line___-_._______- Number of }ines_______�__.__.-_-___ -- ---_'Length of each line ---------- of trench_____{_ ------.Total length---- "------------------ Type of filter material__ !