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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT _ <br />............. ................................... Permit No. .- ---�1'� <br /> (Complete in Triplicate) . <br /> ................ This Permit Expires } 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 <br /> described. This application is made in compliance with County Ordinance No. 544 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION .._.I.._��. .- .C�.....-•- ...... .....CENSUS TRACT <br /> Owner's Name .-0e..r ^- ? -.� ......................... .... .. <br /> .... Phone ..._.._..._.. ...................... <br /> Address ......--..- ���_ than ✓�.... �c� .................. City <br /> w , <br /> Contractor's Name .'- C .License # _��17' Phone <br /> installation will serve: Residence Apartment House Commercial []Trailer Court 0 <br /> Motel ❑ Other .................-......................... <br /> Number of living units:...... .... Number of bedrooms �.....Garbage Grinder ............ Lot Size ............................................ <br /> Water Supply: Public System and name .......-.........................� r �A.� ......e,.ZU� ............... Private ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam [3""' <br /> Clay Loom ❑ <br /> Hardpan ❑ Adobe ❑ 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 /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) r <br /> PACKAGE TREATMENT [ I SEPTIC TANK 11 5i*e.. f� .___X_-G1______A..S•- <br />