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z? APPLICATION FOR SANITATION PERMIT P Permit No. ....? (Complete in Duplicate) z Date Issued Application is hereby made to"the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance'.No. 549. j� �Z_35- 1 .50 JOB ADDRESS A LOCATION 4 1 ► r r -- ---------- , . . _ �.. Owner's Na -- ------ - ---------- ----- ----- -- ------ d�D--o------- ne----------- ----------------- --- #-, Address------ ------ -- -------• ..... ------ - ------------------•---------•--------------=--------------------••----------------------------- a 9 Contractor's Name - Phone Installation will serve: Residence ❑ � par+merit House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: __Number of bedrooms __umber of"baths __ --dot size _____ ---- -° '`_________._ Water Supply: Public system ❑ Commun'ity system E]' Private e. Depth'to Water Table Character of soil to a depth of 3 feet:" Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay)5 Adobe ❑ Hardpan p Previous Application Made: Yes ❑ No New Construction: Yes No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se is Tank: Distance from nearest well--/�_- Distance fro foun ation____,C:_v---------Maf7rial__A_ ____ _ _________ _... No. of.compar+merits-------`--).�----------Size_- - - _-- Liquid defh_- -- ---------Capacity.....�Q �.--- Disposal Field: Distance from, nearest well__/ 0_._Distance from foundation_.. .---- ___.Distance to nearest lot li e...-.a--._... g 0----�-------Width of trench----------Total length--------- �.-'--�C---------------Number of {ines__________l__-_-__ - _ __Length of each line_____ Type of filter material_:_ _rte._ Depth of filter material..._ ---- - -�.. Seepage Pit: Distance to-nearest well___'_________ _______Distance from found;tion__-.