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APPLICATION FOR SANITATION PERMIT Permit No. <br /> -:- — {Complefe in Duplicate) U <br />` i <br /> ` .l— <br /> This Permit Expires I Year From Date Issued 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 compliancey with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCA ION..'__ -"/ _ �`""" , °" <br /> - --------------------------------------- - <br /> Owner's Name------- -------------------------------------------------------- <br /> Address <br /> - _%.. <br /> - ------------------------------------- <br /> ------------- -----------------'---------` Phone <br /> i �.. ._ r '---------- <br /> Address <br /> Contractor's Name - _, x--� -------------- Phone <br /> Installation will serve: Residence Ija"Apartment`douse ❑ Commercial ❑' TiailerI Court ❑ Motel ❑ Other E] <br /> Number of livingunits: __/__ Number of bedrooms _. <br /> �" Number of baths: ".--_ Lot size _"- <br /> - - -------- <br /> Water Supply: Public system Community system ❑ Private ❑ Depth toWater Table -', . ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 0 Clay Loam ❑ Clay ❑ Adobe�ardpen ❑ <br /> Previous Application Made: Yes ❑ No � New Construction: Yes ❑ No- FHA/VA: Yes ❑ No Z�_ — <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> {No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic- Tank: 7 Distance from nearest well-----------------Distance from foundation-------_----------Material-------- --------------------------------------- <br /> 70. <br /> ----._ _ . .-___ -- j <br /> 7 No. of compartments--- ---------------------Size-----•----------------------_..Liquid depth------------------------ Capacity. -------------------- <br /> P <br /> ti . <br /> I <br /> Disposal Fielyi:_. Distance from nearest well...... ...Distance from foundation-_".f -"-."."_:Distance to nearest lot line"" <br /> ' a(, �-••-------- <br /> ` gVri*� Number of lines"(--__`"------- -------" _----"-Len th of each line_"" i� <br /> ff g ei _ Width of trench.-- - - ----•------------- ; <br /> Type of filter m terialJ-- Z,'XDepth of filter material__?.__._ " y, <br /> Total length <br /> See ache Pit: a Distance to nearest well------ ------------Distance-from foundation------ "-.--- Dis ante to nearest lot line"_J___e____ <br /> .4� Number of pits."I_r---------------Lining material__; o6�Ot_Size: Diameter---J ""__-"---"."_.Depth__.X_t�7_! <br />