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l FOR OFFICE USE: .'S <br /> APPLICATION FOR SANITATION . MIT <br /> �.� o �/ <br /> ------------- Permit N. -------- <br /> ------------------ - ,.- <br /> f __ � �.�.- 4Com(Complete in Tri licatel Y .�.._... - -�.� ..---- �--- Date Issued <br /> f <br /> -.�.a -4- - This-Permitires-i-Year•From-Date-lssued , <br /> _ <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 complian e with County Ordinance No. 549 and existing Rules and Regulations: <br /> ' _ . CENSUS T[2ACT <br /> JOB ADDRESS/LOCATION .-- -- -, <br /> ..�° � ---� ------- -` --- <br /> g--- � .. � PhoneT Jj <br /> �!+ 3 <br /> Owner's Name __- �____ - F 0.- <br /> ;Z <br /> / <br /> Address - CitY ---� <br /> Contractor's Name <br /> License # � /� Phone <br /> I r 4 <br /> Installation will serve: ResidenceXApartment House,M Commercial ❑Trailer Court ',❑ <br /> #Motel ❑ Other ---------------------------------=---------- <br /> i <br /> Number of living units:_._____-- Number of bedrooms __,Z-----_--_Garbage Grinder ;^ <br /> Lot Size ------------------------------------ ------- <br /> Water Supply: Public System and name ----_ _______________________________________Private <br /> ---------------------- <br /> Character of soil to a depth of 3 feet: -Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam .E] <br /> x HardpanZI-Adobe Fil[ Material _____.__- -- If yes, type _-------------------------- <br /> ,(Plotplan, showing size of. lot, location of system in relation to wells, buildings, etc. must be placed on reverse, side.) <br /> = <br />