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FOR OFFICE USE: APPLICATION-FOR $ANITATiON PERMIT <br /> 8 <br /> ;I Permit No. _..�-------------- <br /> (Complete in Triplicate) <br />............ ........................................ <br /> �I Date Issued .....'.....--•--.. <br />........................................................ This Permit Expires 1 Year From Date Issued <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 mane in compliance with Co my Ordinance No. 549 and existing Rules and Regulations. <br /> - <br /> JOB <br /> JOB ADDRESS/LOCATION .L���.7 .........CENSUS TRACT <br /> Owner's Name '1°r<S ; - __ -- ......................... Phone;...................................... <br /> A'ddress __..... :/..pp ...................;City .....................................................•�..... <br /> Contractor's Name .::. __'` :: _ :: :.......:'. .Licens'e#: �r3! "Phone' €'"..:........:. <br /> Installation will ..Residence Apartment Havre ] Commercial QTrafier Court <br /> ], 'r• A .. <br /> Motel_Q Other....... ................ .. ; � .,. � w• ., �,... <br /> Number of living units:............ Number of,bedrooms. ....Y..Garbage Grinder .....,..___.r,Lot,Sixe <br /> F Water Supply: Public System and name ............-......•-•...............---'------:..._--------------------- _ __ - _ : .Private <br /> Character of soil to a depthof 3 feet: Sand'Q Silt Q Clay. Q ' Peat 17) Sandy Loam Clay Loam (] <br /> . <br /> , <br /> � IT Hardpan [3; .Q Fill Material ... i .... If yes, ype ------..-----------.......... <br /> y.. <br /> (Plot plan, showing size of lot, location_of.system:.in relation.•to'.wells; buildings,. etc.._must.,be..placed on..reverse .:side.i <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if•public sewer is available Within260feet,) <br /> - . . -" - --- - 'i j• - <br /> PACKAGE TREATMENT [ SEPTIC TANK( j q p <br /> Size - ------ Liquid Depth .......... -••- <br /> Capacity ._ .._._.... Type ................. Material.... :No.' Cornpar''tments '-.................... Da <br /> :.. .... <br /> Distance to nearest: Well `-•---------------- --------------Foundation'..... .... : . Prop. Line <br /> LEACHING LINE [ ] Na. of fines --=----•-'-.--•-_._.._ Leng#h of'each line.... .............:......:... Total length R...... ............... <br /> ._.7 <br /> 'D'. Box � ; _•-.'.'TYP'e'`Filter.; <br />