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TOR OFFICE USE: -<j! c. 73 7 ��5 11 ------------ � 1 . --------- -------"- -"" ----------------------------- - -- APPLICATION FOR SANITATION PERMIT Permit No. .._�_ - ----------- -------------- 1---------- // ----------------- ----- - ---------------------- --- (Complete in Duplicate) , - - N `Date Issued .._.�1.1- 4-y " ----------------------------------- This Permit Expires 1 Year From Date Issued k ZZ�- .�z3—( IF Application is hereby, made to the San Joaquin Local Health District for a permit to construct and install the,work herein described.� ` pp p , -County No 549. J7 This,a Iication is made in compliance with Coun Ordinance a�°g s � S[D� J57 OB ADf}RESS AND LOCATION_': "�, _ _ _:: S _..:. a QIP"1!'f/ R _ " C"' D. •-=---"F ( Phone Owner's Name ------------- .//�� Address----------------r'�-e�.---------G�f.-------��}-�-�r-`�-----_--- _ Contractor's Name-MANTUA---- f k�T{ .5>T Ri�-1 --------- ------ ------------------------------- Phone---------------------- _---------- Installation will serve: Residence e Apartment House ❑ Commercial ❑ Trailer Court E] Motel ❑ F]Other /80 !� Number of living units: J---- Number of bedrooms Nmber of baths`" _� Lot size __"_ """"- ----4___.___"_:_ "- Water Supply: Public system E]. Community sy .tem E] Private Depth to Water Table __ ._ ft, i Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-.- .-1 No IZ- ew Construction: Yes fNo ❑ FHA/VA: Yes gj"No ❑ TYPt`OF INSTALLATION AND SPECIFICATIONS-, _ - - �'� -.:�_- .�-- � - ._¢ J�"'""'+"•`' '�„ (No septic tank ar cesspool permitted if public sewer is avatlabie within 200 feet:)-�, E—f-f9IN Septic T k: Distance from nearest well_-�� e---Distance from foundation--/�-_" Ma er'sal_-.CpN �--------- ` No. of compartments------2_-"""". ---Size"" _x- _"X" -_Liquid depM� -- -------Capacity __" w r