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i <br /> f-OR OFFICE USE: FOR OFFICE USE: <br /> N PERMIT <br /> APPLICATION FOR SANITATIO <br /> Permity -------•----- <br /> {Complete in Triplicate) a <br /> J ----•-------------------------------•---------- Date Issued--/-/_ f <br /> --- _.._..._._.___._.--. __.__ This Permit Expires 1 Year From Date Issued <br /> -------------------- p <br /> E <br /> A plication is hereby made to the San Joaquin Local Health Districtfor.a permit to construct and install the work herein described. <br /> T�__s application is made in compliance with County Ordinance N�o. 549 and existing Rules and Regulations: <br /> trag ADDRESS/LOCATION..._ _.T-_-l-T# v--- t`'`r c- ------------------------- ------CENSUS TRACT---------- --------------------- <br /> .vner's Name------------------ -------------I------------------------------------Phone...4164 _071.1------- <br /> A <br /> ------ <br /> r <br /> Address_ -c- -- City------------- ----- -- Zip----- -- <br /> kmtractor's Name-------------------------------- ------ -------------- ----------- ------License #. `jY'3----•Phone._.��L--T-----1------ <br /> sidencef0tel <br /> Apartment House.0 Commercial ❑ Trailer Court ❑ <br /> ln'stallation will serve: Re ❑ Other---------------------------------------------- <br /> ember of living _ - - <br /> Number of bedrooms..___-."Garbage Grinder------------ Size."-"_ --""" ------------------ ---- <br /> Water Supply: Public System and;name-------------------------------------------------------------------------------- --------------- ----------------------------------Private ] <br /> iaracter of soil to a depth of 3��eet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ p� r <br /> Hardpan Adobe&t Fill Material------------If yes, ty.pe"___________________----------- <br /> ]plot plan, showing size of lot, location of system in relation to wells, building�,!eff. must lee placed on reverse side.) o <br /> EW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is bvailable within 200 feet,) �r <br /> PACKAGE TREATMENT [ ] SEPTIC TANKS ize_.__ ---------- _;____ __ __ _______Liquid De th.__5�.._____.___.___ <br /> ice+ Capacity_P --------TYPe---4109--.4-- -------Mater'i I--. � ---- s No. Compartments---------y <br />