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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> .......... .......... Permit No. .7y- � <br /> r (Complete in Triplicate) <br /> ................................................................................................ This Permit Expires 1 Year From Date Issued Date issued ...7^`'�7 <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 /> JOB ADDRESS/LOCATION ,._.....�..r_ lo._ ... ............:.. ......................CENSUS TRACT ........... ...... <br /> lei <br /> Owner's Name .. :---- Z.• .. -� .N ........ '...........P#�one ....... <br /> .. City .. ...:... <br /> Address ..................?- ._.�.._.��....�_ -c•-n-:�....--••---------�.__..�y.I......_._ y .... __...-----.. ..---•---...... -•-----...._..._._..._............ <br /> © �- .-�-` .. .. ---._.License # .1 ' € -.. Phone <br /> Contractor's Name ...... .. ..�.__.._.____.� ----- ---------- ------------ ...................:........... <br /> Installation will serve: Residence Apartment House E] 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 -------------------------• ....................-_ - : .......................................................Private [ � <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Pea.t❑ <br /> Sandy Loam �Ciay Loam <br /> Hardpan ❑ -Adobe ❑ Fill Material ------------ If yes,type .................. --------- �T <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 seep ge pit permitted if public sewer is available within.200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK[ Size ................... Liquid Depth .. .......................41 <br /> Capacity ja n - Type �..... Material._- !ke..=... No. Compartments A. ................... <br /> Distance to nearest: Well ........... ..................Foundation ........ ....... Prop. Line .... r......: <br />