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FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT �, <br /> -------------------------------------------- Permit No.- <br /> (Complete in Triplicate) <br /> --------------------------------------- ------------ /o- <br /> Date Issued___._.._--_.__._ <br /> ----------------------------------------------.._........ This Permit Expires 1 Year From 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 Ordin nce No. 549 and existing Rules and Regulations:, <br /> JOB ADDRESS/LOCATION ------------------ <br /> - t <br /> � -----..--CENSUS TR-ACT-------------- -- --------------- <br /> -- I - '15-_ ---- --- = Phone--------------- --------- ------------ <br /> Owner's Name---- « G� <br /> CitY ------------------ <br /> ZipAddress--------------------- <br /> -Contractor's Name. ------ License # -- -�-_ _----'----- Phone---- <br /> ...... y ---------------- <br /> Instal la'tion,will <br /> - ------ -:Installation,will serve: s Residence Apartment House ❑ Commercial ❑ Trailer Court, ❑ ' <br /> f Motel ❑ Other <br /> - - - <br /> Number of living units:__'__._ _____Number of bedrooms.:-..__-Garbage Grinder.--'.---- :_Lot Size______ Q--e-.i.:----m--!--_..________________ <br /> Water Supply: Public System and name------------------- ------ ------------------------ - r - ------------------------Private 2r <br /> Character of soil to a depth of 3 feet:/Sand ❑ Silt ❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ . <br /> Hardpan Z. Adobe ❑ Fill Materia(_. __:__._..If yes, type______________________ -1 - •-� ,+ <br /> I (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'septic­tank•or seepage pit per€nitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT-[—] ''SEPTIC TANK [Vl SizeQ_yps ------ ------,�_:�----------------Liquid Depth----- ----------- <br /> }. Capacity_-� A_ b--------Type- Material ..------No. Compartments - - <br /> -!Distance•to nearest: Well.----------- <br />