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FOR OFFICE USE- <br /> APPLICATION FOR SANITATION PERMIT <br /> ------------------------- --------- pAf--- Permit No: <br /> (Complete in Triplicate) <br /> ----------------------------------------------------------- This Permit Expires 1 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 <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: 4 <br /> JOB ADDRESS/LOCATION ._ __ ___ ___ ___ <br /> .CENSUS TRACT -------------- <br /> Owner's Name -- Phone <br /> - --------------- -- -- -- <br /> - `�- -- -- --- --------- ---------------------- <br /> Address -- - � � -�r-�I'44 7-----_`f ------- City _ j -------------------------------------- ------ <br /> Contractor's Name -_-- �r -- ��,o?�^-----------------------------------License Phone _� � k <br /> Installation will serve: Residence &A'partment House-[] Commercial:❑Trailer Court ❑ <br /> Motel ❑ Other --------------------------------- <br /> Number of living units:__/______ Number of bedrooms __(______Garbage Grinder _ _ Lot Size _Z� V. ie____c_______. <br /> Water Supply: Public System and name ---------------------- ----------------------------------- ------------- -----------------------------Private 2 <br /> Character of soil to a depth of 3 feet: Sand Sift❑ Clay .❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe X Fill Material ------------ If yes,type _________________________ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted ifs public sewer is available within 200 feet,) <br /> PACKAGE-TREATMENT ( ] SEPTIC TANKt' Sizee] --� .____ Liquid Depth _ <br />