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FOROFFICE USE: <br /> --------------------------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ---------------------------- -------------------------- (Complete in Duplicate) <br /> --- -------- This Permit Ex ires 1 Year From Date Issued Date issued ..t����(-_-3 <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 <br /> with County Ordinance No..549. <br /> JOB ADDRESS AND LOCATION,If -1 .-/ •, '` ..`------------- --------........-----•------- <br />- 4 <br /> Owner's Name. ----- -- - ----- -------- -•-•--•-------- ---------------- Phone.................................... <br /> Address ?'•--.. �-+ <br /> Contractor's Name_- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mot 1 ❑ Other ❑ <br /> Number of living units: .---_ Number of bedrooms _-�-_-- Number of baths .-1-_-- Lot size ...... <br /> Water Supply: Public system ❑ Community system ❑ Private P] Depth To Water Table --%3,0. ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 8 Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No PE New Construction: Yes IM No ❑ FHA/VA: Yes ❑ No <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-��_�_-.-_ Distant f m foundation----1�7.........Material.. �' <br /> --------------------------__�f� <br /> No. of compartments..----- '--_----------Size- __ ..-....._Liquid depth--------�_____--------Capacity.� �.✓_._ <br /> Disposal Field: Distance from nearest well_-SP---------Distance from foundation...?-----------Distance to nearest lot line...-! <br />