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FOR OFFICE USE: i SAFOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> --------------- ------------------------------p <br /> i� (Complete-in Triplicate) Permit <br /> -------------a-----------------------------•-------- --- <br /> i: <br /> Date Issued._ =�_�_ <br /> -------------------------------------------------__ This Permit Expires 1 Year From Date`lssued <br /> Application is hereby made to the San Joaquin Local Health District for a permit toconstruct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/ OC TI N___ S SCa_-. -- ---l�-`--- Q_!,D_L4L --:- ------- --..-_]---•_.[_ _.CENSUS..TRACT__ C F ---- - <br /> D <br /> j <br /> ` 'J <br /> Owner's Name. 'g ------------------------ Ph <br /> -- one,_- L �! <br /> 1J <br /> �} . . <br /> Address ........__ <br /> x <br /> - city e-44 Zip <br /> Contractor's Name_ --- �(J ._.._1. - � ------------------------- Lice'nse #__j ----Phone_,___�_6--_-'-Q�3 <br /> Installation will serve: Residence ❑ Apartment Houk❑ . Commercial ❑ Trailer Court ❑ ; <br /> Motel ❑ Other_ -'------------- <br /> Number of living units:._____ ____ANvmber of.,bedrooms_._o2,___Garbage Grinder_._'________Lot t Size----I_a4A_e o_______________----------------------- <br /> Water <br /> _____.___._.___-__.Water Supply: Public System and name: : , '. - =--------------• ---=----------------------------------.------------------------------------Private [�! <br /> Characterho soil to depth of�3 feet: Sand ❑ Silt E] Clay ❑ Peat E] Sandy Loam L] Clay Loam � l i <br /> Hordpan ❑ Adobe E] Fill Material......:......If yes, type <br /> [Plot plan-,howiig]size of lot, location of system in relation to•wells, buildings, etc. must be placed on reverse side.) <br /> NEW iNST LLAT_1&: [(No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGEjTREATMENT '[ ] SEPTIC TANK jG]! Siie_______. .____/�__ ___ __! <br />