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FOR OFFICE USE: <br /> --------------------------------------------------- ----- <br /> ------------"' <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> -------- ------------------ ------------ --- --- {Complete in Duplicate} <br /> --------- - --------•- This Permit1x fres I Year From Date Issued Date Issued <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. 0f3 — 100 <br /> O ADDRESS <br /> J <br /> , C--o C-7- ' r : } <br /> SSA LOCATION)V4."._ <br /> ------------- -- <br /> Z <br /> e Phone <br /> --- -------------------- --------------------------------------------•----------------------- r - <br /> Owner's am ` <br /> Address---------- -•-----k <br /> �o•ntractor;s Name_: :- -- --- one <br /> ---••--- ---- <br /> _. <br /> -----------P <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Tkailer Court ❑; Motel ❑ Other ❑ <br /> - ---� <br /> Number of living units: _/_._7 N Der of bedrooms _-/Number of baths _�ot size -----------____________________________________________ <br /> Water Supply: Public system ❑ Community system ❑ Private [l' De7clayLoam <br /> Water Table -------- ft. <br /> Character of soil to a depth of 3 feet:Sand ❑ Gravel E] Sandy Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made. (If yes,date--------------- ----) No ElNew Construction: Yes E] No FHA/VA: Yes ❑ No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: �_ <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> p No. of compartments 9 � S �- Ln �v Material._Cor..as ------------------------ <br /> Se tic nk: <br /> Distance from nearest well_---------------Distance from foundatio <br /> iquid depth:------ ......-- --Capacity--- <br /> p -- <br /> Dispos Fieldk <br /> Distance from nearest well.__S�-`r <br />