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}' APPLICATION FOR SANITATION PERMIT Permit No. <br /> y� (Complete in Duplicate) Date Issued .. � 5�4 <br /> CJ '7 _ o��--37 <br /> Application is hereby made to the San Joaquin Local Health District for a permit to consplruct and mstalf the work herein described. <br /> This p <br /> t r Z p licattioon ismap y e.m.com compliance wi h Count Ordinance No. 549 4 <br /> `I JOB ADDRESS AN OCA � � �f ! <br /> Owner's Nam . : --------------------------- ------ ------ ---- one .------------------- <br /> - <br /> Address -.�..`-....... • ----------• = ,-----------------------•---------------------------•---- <br /> jContractor's Name--- ---------- - ------------------------------------- •---- Phone <br /> Installation will serve: Residence Apartment House E] Commercial ❑ Trailer Court El Motel F] Other ❑ <br /> Number of living units: j____ Number of bedrooms _ _ Number of baths _1._.. Lot size _______________________________-__.___.__------__--___._.-_ <br /> Water Supply: Public system ❑ Community system ❑ Private)0 Depth to Water Tabld-_Q_ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Nr Clay Loa Clay ❑ Adobe ❑ Hardpan ❑ ,� <br /> Previous Application Made: Yes ❑ No New Construction: Yes No ❑ N <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: A <br /> (No septic tank or cesspool permitted if public seer is available within 200 feet.) --_.________.____. <br /> No, of compartments---------Zr--_______._Size-3-;; s�-,r .i Liquid depth____ ___________ <br /> Disposal Field: Distance from nearest well_ _?_Distance from foundatioP__4_S'....Distance to nearest lot gine_________________ <br /> Number oi lines______._ -___L,�Length of each kine_____V_._ _____r�._____._.Width of trench. '�. ____-____-______. <br /> Type of,filter material._-y__ _______ _ Depth of filter material--,/5,7-0 <br /> ---------Total length---/,; _A_______________________._ <br /> Seepage Pit: Distance to nearest well_____.______.____._Distance from foundation___________________ Distance to nearest lot line__._______.___.__ <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- <br /> i <br /> Cesspool: Distance from nearest well____________--__Distance from foundation---_----------------Lining material-----------___..________.____.____-. <br /> ❑ — _,Size: Djarnefer--= <br />