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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT 7� <br /> PermitNa:. ................... <br /> .. (Complete in Triplicate) . . - <br /> Date issued 11,1-7,1 <br /> ... .....:..... This Permit Expires '! Year From Out Issued <br /> Application is hereby made to the San Joaquin local Health District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulotions: <br /> 2 .....................CENSUS TRACT JOS ADDRESS/LOCATI �O'fr --�7•' T� '""' --•----•------�----- t <br /> �Gl, - ..Phone .._ ... <br /> Owner's Name" ,....... :...-..... <br /> Address __ ........ ._ . 2.�7 -..._....City ._... ..#..._ - - 64_... <br /> a w- License j _..._ Phare .- <br /> Contractor's Name :"�............ .......�, -- --- ---- -- ---------- <br /> .. : <br /> Installation will.serve: Residence Apartment House Commercial❑Trailer Court ❑ <br /> Motel ❑Other. .-.-- .. --------- .................... <br /> _. T5._ <br /> Number of living units ..... Number of bedrooms _...........=Garbage Grinder ............ Lot Size ............... <br /> .Private (� + <br /> Water Supply. Public System and name .................................__----------••-•--T-�-----•....--...._:._.................._..__......_.. � N <br /> Character of soil to.a depth of 3 feet. Sand❑ Silt❑ Clay Q Peat.❑ Sandy Loam 1� Clay'loom <br /> Hardpan❑.t Adobe o ......Fill Material ._._:, If yes,type.......;_...... ............ <br /> . t <br /> (Plot plan, showing size of lot, location of system 1n relation to wells, buildings, etc. must "be-placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage p1t permitted If public sewer is available within 200 feet,) <br /> Sias__.. Liquid <br /> PACKAGE TREATMENT " ( ] " SEPTIC TANK; ) Depth <br /> i I 'Capacity YP '` Material.... '--_-•- -- <br /> No. Compartments -------------------- <br /> Distance to nearest: Well ... Foundation I .Prop. Line .............:.......• <br /> LEACHING LINE [,j No. of tines ---- ------ length of each Zine- •.... Total Length <br /> ., D Box Type Filter Material .Depth Filter" Material _--=-...... ._... <br /> ....._-_.._. ••--- . <br /> h Distance to nearest: Well --------- .............. Foundation ....... Property Line -------------- <br /> .. Diameter 't'A�L- �: <br />