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5� Permit No. <br /> APPLICATION F( )SANITATION PERMIT <br /> (Complete"in Duplicate) Date Issued x_5_ ��p <br /> } I <br /> F Applica+ion is hereby made to the San{Joaquin Local Health District for a permit to construct and install the work herein described. <br /> his application is made in ��ompliance with County Ordinance No. 549. <br /> ° I <br /> JOB ADDRESS AND LOCATION --- 13 - ._.�'-^---- =---------------- -----••-•------------------------------------------ <br /> '� <br /> Owners Name_ a__ ---- ' -------- <br /> ------ <br /> Phone '2 <br /> .�. <br /> �r ��-- <br /> Address--------l..l-�--�- -�--��,�,±�..k----- ------ -----•---------�----------------------------------•--•--•----•----------------------------------------------------------------f <br /> Contractor's Name 1 --•------------------------------------------------------------------------ ---------------------- Phone_txT .-3. 1_ <br /> Installation will serve: Resi'Lnce [R�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living unit: ___;___ Number of bedrooms __-'Number of baths ___ _-_ Lot.size -----------to----_-.- <br /> ' Water Supply: Public system ❑ Community system ❑ Private �epth to Water Table ________ ft. <br /> Character of soil to a dept of 3 feet: ^Sand . Gravel ❑ Sandy Loam , Clay Loam ❑ Clay ❑ Adobe�rdpan ❑ <br /> Previous Application MadeI[ND <br /> Yes ❑ No New Construction: Yes.�o ❑ <br /> I <br /> TYPE OF INSTALLATION, SPECIFICATIONS: <br /> I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Ta k:. V well _._-_Distance from foundation____________ Material___-______._____.________________'-__________- <br /> 1 No. of t <br /> ompartments- -- -------------size_-.----•----------------•-------Liquid depth--------------------------Capacity:- -------•----------- <br /> Disposal Field, Distanc from nearest well......... -....`.Distance from foundation____________________Distance to nearest lot line___-______-_____- <br /> Numbe�b of lines x----------------------------`--Length of each•line------------------------------Width of trench.---------------------------------- <br /> Y" Typeof filter material----- ----------------Depth of filter maierial------------------------Total length--------------------_-------------------_- <br /> Seep -------Distance from f andafion-----J,�?_-___.Distance to neaCN-01 Numbers of pits___.}___________ __Lining material_&,vt �-__-Size: Diameter-------3----__-.____Dep �_ <br /> See a �t: Distance to nearest well__,___L <br /> Cesspool: Distad from nearest well-----------------Distance from foundation--------------------Lining material-_._______________________________ <br /> g Size: Diameter---------------------------------------Depth------------------ <br />