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FOR OFFICE USE: ------------------ - - --------------------------------- ----------------------ut-------------------- APPLICATION FOR-W41TATION PERMIT Permit No. ---------------- --- -- --- --- (Complete in Duplicate) Date lssuecl .J77�—�---��-;�' ------------------------------ ---I- ---------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND Owner's Name---------�Ilcay-----41 lZe 21-42�� ------------------------------------------7------ -------------------------*------------------ Phone------------------------------------ Address .......A/...... Contractor's Name--------- ------------------------------------------------------------------------------------ Phone----------------------------------- Installation will serve: Residence Apartment House [] Commercial Fj/Trailer Court H""Motel El Other El Number of living units: --/--- Number of bedrooms 2--- Number of baths Z---- Lot size -1��eoolje-49;?-f --------------------------- Water Supply: Public system E] Community system E] Private PT""Depth to Water Table 1�4� ft. Character of soil to a depth of 3 feet: Sand F1 Gravel [-] Sandy Loam El Clay Loam El Clay [--] Adobe UT--Hardpan Previous Application Made: (if yes,clate--------- ---- ---- ) No Er"New Construction: Yes 6allo E] FHA/VA: Yes R�— No ot TYPE OF INSTALLATION AND SPECIFICATIONS: (No Septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest Distange fr9m foundation / -1--------- -- 4:!� Mat 94-1- No. of compartments--- - ----------si,,Xk,�.....-- -3?(i q u i d d e P�h i �----------Capacity/4- 4eq- Disposal Field: Distance from nearest well--4e' -------Distance from founclation-AZ9----------Distance to nearest lot line-A,'J-7--------- Number of lines.-----1A------- -- -------�.ength of each line--��O-----------------Width of french-A." ----------- 11*� --- --------------- ' Type of filter mat eria i Depth of filter material--- ----Total length--Z.-Ole- ------------------------- 01 Seepage Pit: Distance to nearest well---ZW7e Distance from fognclation--416�.........Distance to nearest lot line---,�--------- Number of pifs-...-.l--------- --Lining material -1140P-ellr- Size: Diameter--- D e p f h Cesspool: Distance from nearest well ----------------Distance from foundation----------------- ..Lining material------------I------------------------ F-1 Size: Diameter- -- --------- ----- ----------------Depth-------------- -----------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------------ --- --Distance from nearest building----- ------------------------------------ F] Distance to nearest lot line-- --- --------------------------- -------- ------------------------- V Remodeling and/or repairing (describe):--------- ------ -—------ ------------------------------------------------------------ -------------------------------------------------r- -------------- ------------------------------- ------ ------------------------------------------------------- ---------- ------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------- ------------------------------ -------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. C (Signed)---------------- ---- ----- or Contractor) _3 in ----------------------------------------------------------- By:------------------------------------ -------------------- -1�� (Ti f I e) -140-1---------------- - -------------- -------------------------------- (Plot plan. showihg size of lot, location of-s ern in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------- ----------------------- DATE.... REVIEWEDBY---------------------------------------------------------------------------------------------------------------------------- DATE BUILDING PERMIT ISSUfl)----------------------- ---------------------------------------:-------- ------ ---- -------------.. DATE---------------------------------------------- ----------- Alterations and/or recommendations-----------------2!---------------- ---------- ------- -------------I-----------I---------------- ---------------------------- ------------- ------------- ---------------------------------------------------------------------------------------------------------------------- ------------------------ ------- ----------------------------------------------------------------------- ----------------------------------------------------------------------------------- ------------- ------------- ......--------- ------ ---------------------- ------------------------------- ------------------ -------------------- ---------------------------------------------- ------------------------------- ---- -------------------------------- ------ ---------------------------------------- -------------------------- ---------------------------------------------------------- ------- 7' FINAL INSPECTION BY:..--- ----4047. Date------- ----- - ---- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 12 4 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California