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APPLICATION FOR SANITATION PERMIT <br /> (Comple+e in Duplicate) <br /> - . <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION---------1QQ_4--S- Gcr_t22__d_Q---------------------------------------- ------------------------I-------------------------------------- <br /> Owner`s Name-------------Z,C771.lSa__�'-1Bming <br /> � r-------------------------------- - - Phone---___�___�_63Q--------------- <br /> AddressOQ-4_- =+-•- _S:1'_ Lid ----------- --------------------------------------------------------------------------------------------------------------------------------- <br /> Contractor's Name-----------D1ta--------------------------- ---- ---- --- ----------------------------------------- ---------------------------- Phone--__7: 7----------------- <br /> Installation will serve: Residence U Apartment•House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: r Number of bedrooms fa, Number of baths [I Lot size---75---x 150___________________________________ <br /> Water Supply: Public system :E] Community system ❑ Private ❑ f Q <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobes E] Hardpan ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank:. Distance from nearest well_________________Distance from foundation--------------------Material __________________.--------------------------- <br /> _- <br /> No.-of compartments----------2-------------Capacity-----8-00---------Size-------------------------------Liquid depth-------------------------- <br /> -Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material-----------------------_---------____. <br /> ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------------------____________._. <br /> [] Disfiance to nearest lot line___________________________________________Y_ `f <br /> Seepage Pit: Distance to nearest well-------- -----------Distance from foundation--------------------Distante to nearest lot line___________._____ <br /> Number of pits-----2_` -----------Lining material___��iGk-----Size: Diameter_ ----Depth._c+ AfJ _ <br />