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APPLICATION FOR SANITATION PERMIT Permit No. .._ /.. 3- <br /> (Complete in Duplicate) / <br /> -- Date Issued _._ <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 County Ordinance No. 549. <br /> JOB ADDRESS AND L C T ON l------4_6�C�--------"5.c_�r-`--()N 4 V e ' <br /> � � , <br /> Owner's Name �_IZ --------------• ---------------------- Phone-111141 <br /> Address--------------- ... <br /> _ ------------------------------•-----------------------------•---------------------------- <br /> ------ ---- ----------- -•-•----- <br /> Contractor's Name------- ��_> � .ty j5�� Phonel4�r.* -�---�1-'��•7__ <br /> Installation will serve: Residence 0fpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ---j_- Number of bedrooms ___2_ Number of baths __.t!___ Lot size ------/D�X ..•------_ <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table .5___v ft. <br /> Character of sail to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [B —Hardpan ❑ <br /> Previous Application Made: Yes ❑ No ®/"New Construction: Yes ❑ No ®--- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permiffed if public sewer is available within 200 feet.) <br /> I <br /> Septic Tank: Distance from nearest weli_hkA`E-Distance from foundation____ --��--�-..Material.... --------- <br /> -- -------- <br /> f i �Y: : <br /> �~ No. of compartments.- --------- .Sizer ------Liquid depth-----� -,.x .....--. Capacity ems--`' � <br /> Disposal Feld: Distance from nearest weil__l 6Webistance from foundation__ a°._�___-Distance to nearest lot line_ -_7_.0 <br /> ❑� Number of lines---------------- fr_._______Length of each line_"_____�S� f.----.._.Width of french.____ _" �� <br /> --------------- <br /> Type of filter material__-_ ' S <br /> __. '0--Depth of filter material------/ length______-- <br /> ---------------------------- <br /> Seepage Pit: Distance to nearest well--./_V!2,1rf Distance from foundation___,6'D--/.___ Distance to neares <br /> Number of pits-------_-/---------Lining material----el__ <br />