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'----- ---------FOR OFFICE USE: <br /> - --------------_------ ------------------ _ <br /> ----­------------------ ----------_____________________ APPLICATION FOR SANITATION PERMIT Permit No. ...."�_-_......... <br /> --- -------------------------------------------------- (Complete in Duplicate) `�- <br /> Data issued <br /> --------- --- This Permit Expires l Year From Date Issued a.....".......� .. <br /> Application 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 LOCATION--------------- <br /> ------- -------------- .dx'-,.nr-------- <br /> �[ <br /> Owner's Name----------------- .__.._..�9.: .2 ?-.ryrl_--•- - Phone----------------•--- <br /> ---------------- •--------------------------- -------------- <br /> Address <br /> -- <br /> Address------------------ <br /> Contractor's Name--------- -- --------- <br /> -_ - -•----------------��' �� ,� ---------------------------------- Phone-----...------ •--•---------------- <br /> Installation will serve: Residence�?. Apartment House ❑ Commercial E]. <br /> Trailer Court ❑ Motel ❑ Other ❑ t <br /> Number of living units:'/._'—. Number of bedrooms _ _. Number of baths __,_-_,.Lo#,size-. J.J� _.'`=_ <br /> Water Supply: Public system/® }Community system ❑ Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay o Adobe[}7s Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No Pg New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: "` r <br /> (No septic tank or cesspool permitted if public sewer is Available within 200 feet.) f `. <br /> r � <br /> Septic Tank: Distance from nearest well___ ____Distance from foundation___:_Jp`......Material----- <br /> •P -rte .:....--.- <br /> ...._.... <br /> 1Z No. of compartments___.-_:.2_____________`Size ` .X. __'°��.___Liquid depth-.-___,' ._.._________Capacity...... _--G....... <br /> Disposal Field: Distance from nearest well-- -r? Distance from foundation...l'C? :-.._.Distance to nearest lot line---A.......... <br /> 0 Number of lines------------_____ ___ __ Length of each line----------- 'G'_`.......Width of trench..---.------ �_-'__________ <br /> Type of filter material....... .__Depth of filter material___ <br />