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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> - --------------------------- � Permit No. - ,� <br /> ---------------- <br /> (Complete in Triplicate) <br /> ._._,__________________________________________-_-_--__ This Permit Expires 1 Year From Date Issued <br /> Issued <br /> Date -------------------- <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 Regulations: <br /> Own er'DS NamSeLOCATE l r l ! - *� : CENSUS TRACT S------------ <br /> l <br /> a z.�e� ..1.� <br /> Phone <br /> Address �o 0-/, - City <br /> Contractor's Name -? �------License # -���? Y Phone ----------------- <br /> Installation will serve: Resident ❑Apartment House E] Commercial ❑Trailer Court ;❑ <br /> Motel ❑ Other 72'?_O-4-,�-X___ <br /> Number of living units:------- Number of bedrooms __�2,—Garbage Grinder ____.____._ Lot Size ____ ______________�_____ , <br /> t I <br /> Water Supply: Public System and name --------------------------------- ----------------------------------------------------------- ----------------Private <br /> Character of.soiI to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam �. <br /> Hardpan [❑ Adobe.0 Fill Material ------------ If yes,type __________________________ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, .etc, must be placed on reverse side.) <br /> 0 r <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) lv <br /> PACKAGE TREATMENT [ ] SEPTIC TANK ['j' Size X._._9�)'___�`—____� q p -- <br /> �Q Liquid Depth <br /> Capacity _� dam_. Type ____ Material___ s _.�__ No. Compartments -___�------------- <br /> Distance to near t: Well _-_-___.--- CO '_______________Foundation ____._��'____.._ Prop. Line __S__ ___: <br /> - - -------- <br /> LEACHING LINE No. of Lines ----- _____-------- Length of each line-------Sa__ ------ ------ Total Length ;___tno__----____--__ <br /> 'D' Box -Y_n.__-._ Type Filter Material........�(Z_:_.Depth Filter Material -------j__9--------------------- -•.----- <br /> Distance earest: Well ------------ =_v Foundation ------ .0- ........... Property Line- ------S- <br />