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FOR OFFICE USE: F� SGv! S ° r L� <br /> ,4�P KATION FOR SANITATIONPERMIT t72.?/S-1� <br /> (Complete in Triplicate) <br /> Permit No. .7�_ -- -- <br /> ______.____._ This Permit Expire 1 Year Fro Date Iss Date Issued -/--1-"_7(. <br /> Application is hereby made to th7Sa7joaquin L6ca1 Ffealth D'istr2 _fo'r 'a'7_p�errn4t to construct and install the work herein <br /> described. This application is made in com Ilan with untJ�Ordinance No. 549.and existing Rules and Regulations: <br /> AOL-JOB 'ADDRESS/LOCATIONh1__.._--____ -__ _ �•�`"�' <br /> - �u Z -� �_ G77CENSUS TRACT <br /> Owner's Name -------- 11�. --� C�'.�_ 1 ------- --------- ---------PhoneA�-_---4 <br /> Address 3� - �" city <br /> -- ----- ------------ -•------- . -�----------_- <br /> Contractor's Name -----_ ,,,?, _/.`U /���,, <br /> E � <br /> -- -;-r�s/� -----------------------------------------------License # ����Z��Phone <br /> Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court ,❑ <br /> i <br /> ' Motel E] Other ------------------ ------------------------ <br /> Number of)living units:___ --- Number of bedrooms .__ ____---_Garbage Grinder Lot Size <br /> Water Supply: Public System and name ------------------------------------ - _-_Pr vate <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam <br /> Hardpan ❑ Adobe,E] Fill Material ------------ If yes,type --------------------------- <br /> (Plot <br /> ------------------- _•(Piot plan, showing size of lot, location of system 'in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septictankor seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ 1 SEPTIC TANK'[ ] Size__ _ :__ <br /> r ��Y ?�- - Liquid Depth --- © <br /> Capacity _/W" ----- Type)MrF_Material------------------- No. Compartments -------------- <br /> Distance to nearest: Well ----___________________ �_Foundati -a--_-_.______- Prop. Line - ,__.-.....__. <br /> LEACHING LINE [ ) No. of Lines ____ _______________ Length of each line- ------- Total Length ra.f <br /> E `` / ' b <br /> D' Box .. �____-- Type Filter MaterialfY�-:depth Filter Material _.__� __�-------------------------• <br /> S <br /> Distance to nearest: Wel! -___ _f-.----_ Foundation __l--D___.' <br />