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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) �� i <br /> 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. f ; ' <br /> JOB ADDRESS AN[?/LOCATION------- ------- -_ d rt <br /> Owner's Name ---- Phon i ---- <br /> 3�2 <br /> Address <br /> - -- <br /> Contractor's Name------ ---- - ---- ---- - 4fher <br /> Installation will serve: Residence Apart ent House ❑ Commercial E] Trailer ourt ❑�Ivlotel L] ❑ <br /> Number of living units:: _ ___:__ Number of bedrooms -/_.- Number.of bathe--- Lot size _ - ----------------------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private 9- Depth4o Water <br /> Character of soil to a depth of 3 feet:. Sand E] Gravel E] Sandy Loam Clay'.Loam ❑ Clay [2 Aclobe0 Ap Hardpan ❑ <br /> Previous Application Made: Yes E] Nod New Construction:�Ys No ©' FHA/VA: Yes No ' <br /> y TYPE OF .INSTALLATION AND SPECIFICATIONS: } <br /> (No septic tank or'cesspool permitted if public sewer is available within 2DD feet.) <br /> No. of co <br /> Septic Tank: Distance from nearest well_________________Distadce from foundation____----- ----___--Material_____..____.__..______-...____.._______.________. <br /> ti. compartments maize---------/--•--------------Liquicl�epth--------------------------Capacity----------------------- <br />- Dis os Field: r ' foundation <br /> = p e Distance from nearest well___,-___ ._Distance from ________----_---_.Widthcofttrenchest lot line_________________ <br /> Number of lines------------- -------- --- ---Le th of each line_ -------------------_--------------- <br /> 7o <br /> ----------_- i <br /> Type of filter material_____-_- -. t <br /> , 4A h.o i e r a -Toal_lengh- -- ---- -- -- <br /> --- - - ------------ <br /> p e <br /> See age Pit: �iiu�abee of n}aresti weld �in ma e: <br />