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APPLICATION FOR SANITATION PERMIT Permit No. __,f-7__ (Complete in Duplicate) Date Issued Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. J JOB ADDRESS AND LOCATION---------- Oj�____�_-'____ ___ '__.---'.___------`-- �-----y---------T -------------------------------------- Owner's'NName_.,9 7_ ._ v_t _ -•- -# r+-- •- -- - ----- - .------------- Phone-- Addressfid`------'�----- �-�1u.> --•-------------------------------`------------------------------- Contractor's Name----------- -------------------------------------------------------------- ------ Phone-------------_-------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _--� umber of bedrooms __�_,_ Number of baths I--- Lot size ------{�__6 _��__f�__�_________________ Water Supply: Public system ommunity system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: S� ew d�i] Gravel r❑ Sandy Loam E] Clay Loam E] Clay El Adobe ❑ Hardpan ❑ Previous Application Made: Yes El No Construction: Yes E] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi Tank: Distance from nearest well-------6�C�____Distance from foundation-----IU________.Material__________.__ -T______________ No. of compartments---------- ---?J---Size-------y--- ' -- __Liquid depth---------y t-----------Capacity...._-_- ------ I Dispo I Field: Distance from nearest well----- A_-_---_Distance from foundation______2V___-__.Distance to nearest lot line------S________ Number of lines-------------/----- -------------Length of each line------------��_s_--------Width of trench----------