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'<rly APPLICATION FOR SANITATION PERMIT Permit No. ___ - 5 <br /> (Complete in Duplicate) �� �� <br /> pate Issued ------- -_� ------ <br /> Tglica+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.,544. <br /> ,�j �� = ----------------•-•------------ <br /> JOB ADDRESS AND LOCATION J� '�` --2.-----!/l <br /> Owner's Name- --- "-- / -CLc < ter. 1_ ,>. , Phone------------------------------------- <br /> --- <br /> - ------ -- <br /> - , <br /> Address--------- _`a`_ - <br /> Contractor's Name--- ---------- ��r�►� Phone__ _ _. <br /> ----- , <br /> Installation will serve: Residence �i partment House F-1Commercial ❑ Trailer Gourt ❑ Motel El Other ❑ <br /> Number of living units: ___j.-- Number of bedrooms __Number of baths .-1___ Lot size ------- --- --------------•------- <br /> Water Supply: Public system ❑ Community system ❑ Frivate _-Depth to Water TableS.9 ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ft--Hardpan ❑ <br /> Previous Application Made: Yes ❑ No RI--New Construction: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic ank: Distance from nearest well_______________-Distance from foundation-------------------Material------------------------------------------------ <br /> r- No, of compartments ---------- Size Liquid depth Capacity r <br /> isposal Field: Distance from nearest well__._..__Distance from foundation._I.4...........Distance to nearest lot line..sts__•_-_-_-__ <br /> �--- <br /> of each line._---- ---- -------Width of trench ------------------- � <br /> Number of lines-----------1 -------_Length r <br /> Type of filter material___/..rf.,_________-Depth of filter mate _.___.___.Total <br /> length---,f` _---------- -------- <br /> Distance - ---- W <br /> Seeppe Pit: Distance to nearest well--1 .�7 __ from foundation___ b.j--.--.Distance to nearest lot line____ ___ N <br /> �g — ` . ' - ---Dept n....'2_ ---------------•--- <br /> L`)r Number of pits.._.____/__._____Lining material___ ► -r .Size: Diameter__: <br /> I: Cesspool: Distance,from nearest well----------------- from foundation..... material___________________ <br /> ❑ Size: Diameter -------�T Depth- - <br />