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FOR bFFICE USE: i <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No: 1 ,?7 <br /> - -------- <br /> ---------------------- - - -- <br /> (Complete in Triplicate) <br /> ----------------------------------------------------- :r1 Issued ---Date -7------z---3------- <br /> J <br /> This Permit Expires 1 Year From Date Issued <br /> _ � <br /> Application is hereby made to the San Joaquin_ Local Health District for`a permitwto 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 /> r {r _ .�. �-- Dom _---- -- ------CENSUS TRACT __.t- =_•- -------- <br /> JOB ADDRESS LOC;4T,O[-1 ==" = == .. <br /> { �y� Phone.----- - <br /> Owner's Name �-�-��-�'-=---- - - �-t-�N ------��-i��-�_��_�� - ------------ - ----- ------•-- ------ <br /> + ---------- <br /> Address = ryD ----------- ------------ City . , <br /> t }: ` Phone ------------------------------ <br /> Contractor's Name _._ ------- -- - --- -------- ---� License # ---------:-- <br /> Installation will serve: Residenc artment House Co mercial :❑Trailer Court ,❑ <br /> Mote[ ❑ ther --- ------ <br /> I <br /> ---- l <br /> Number of (iving�units:____ ---- Number of bedroom-------Garbage Grinder ----- ------ Lot Size - - <br /> 1 _ --------- ----- <br /> Water Supply: Public System and name -------- ----------------------------------------- <br /> _ <br /> ;vat , <br /> Character of oil to a depth of 3 feet: - Sand'❑W Silt ;_+flay [ Peat 0"' San'dy Loam Clay Loam❑ <br /> E Hardpan ❑ Adobe.n Fill Material -- If;yes,type - � -----{�. <br /> (Plot plan, showing size of lot, location of system-in,jelation-to wells, buildings, etc, st.be placed on reverse side.( <br /> .. <br /> p seepage pit permitted if pu)blit sewer is available with in'200 feet, f� l <br /> NEW INSTALLATION: (No se tic.tank or <br /> SEPTIC TANK' Size /� � __ -------- Liquid Depth........ <br /> PACKAGE TREATMENT { ] _�. ,,�g, � �. <br /> 5 j- I6•�J - NoF Compartments i <br /> Capacity y��� ---- Type ����.�L__ Materia '- - -- } <br /> }[ Distance to nearest: Well ______ G'----- <br /> 17--------Foundation -/Q---'-�----- Prop. Line _____-5 l� <br /> r Total Len th _�- ---.--•---- <br /> LEACHING•l INE�No. of Liines J-3-------------- g ,o ------ <br /> Len th f,.each' line: _-_• T g <br /> r l - <br /> --.– w k Type Filter Material' 1Depth iRiilter Material _ <br /> Box r -- -�i j�� �'. <br /> r Pra er ° Line ___ ----- <br /> Distance to nearest: Well -- �. <br />