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APPLICATI N FOR--ANITATION PERMIT Permit f. (Complete in Duplicate) ` -- I _ w,-Date•Issued --`�--•-•-3---�--� --- r t Ii , Applicaa-ion is hereby made to the San Joaquin Local Health District for i permit to construe#and install the_work herein described. This application is made in com' pliance with County Ordinance No. 544. JOB ADDRESS AND LOCATION_____z�09.-5_.--_Golden-.G�t --------------••------------------------------------• -------------- -- ------------ Owner's Name----�?,_----w__---F'araelas, Renter: _-Mrs..Be,' tiara Franklin phone--ph'---_ �.----5 55 R70 Acacia Av. , North S- ------------------- Address --------•----------=-•--------------I— aCI'iAII1Ci1Ii0 Contractor's Name__P_e1Xa 1'. •-••----------------- Phone__3--129------ ------ Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: sems ____ Number of baths .1- Lot size --------------------------------------------------------- Water acres-- -------•-------------•-------------- Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table ft. Character of soil to a depth of�3 feet: 'Sand ❑ Gravel ❑ Sandy Loaf ❑ Clay Loam ❑ Clay ❑ Adobe IN Hardpan ❑ Previous Application Made: Yes ❑ No [;� New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: J t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) + p om nearest well------50------Distan`e from foundation__-_Za_�-.._--.Material �.c:Cm--------------------------------- No. nt Septic Not of compar#meats------ -----------------5ize__k' x __ x4i R 1 11---------Liquid depth---5r------. &---3 Capacity__C_i�}--------- Disposal Field: Distance from nearesf well----------------- from f oundation--------------------Distance to nearest lot line---.----__--..-__ Xlsting Number ofjllines------------------------- --------Length of each line-------------------------.---_Width of trench--------------------------'-- # Type of filter material-----------_---------:--Depth of filter _aterial------------------t----Total -length-------------------•............. ----_-__ Seepage Pit: Distance to nearest well._--_ _-;__Distance from foAnda+ion__.lq-P___.D'stan e to nearest lot line__- ® { Number of ipits----- ------------`Lining material.---ro_Ck_Aw_--Size: Diamete�___2��---- -------Depfn----- 0-1-----------!--__---- Cess❑pool: "Distance Dis a ceD�amem nearest well-----------------Distance from fohndation-------------- _....Lining material--.--.__. (� ----------------------------- t 'ter Depth -----------------------------Liquid Capacity-.- •------------------------gals. PrivyPriv _ € Distance rl l ! om nearest well -----------------------------------1-Distance from nearest building-------------------------------------- ❑ Distance +olMnearest lot line---------------•------------- ------- r �.. Remodeling and/or repairing (describe]: n °_FTJ .0--t-8-11 -•�0_-_T"CfJlaee___C-v Cd 1-n Se-tiC tank --------- -----------------; -•----------------------•----•-- -----•--- If -------------------------------------------- --------- ---- "F'"� '` f ----------------------- --------------------------- ------•------.....---------------------•-•--------------------------------------------•---------------------------------------- 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. _ DC1 t ---- t" (Signed)------------------ ........ --------------------'--------------------- ----------------------=------------•-----_•---'---------------�(Owner and/or Contractor) � F $Y--------------------- ----------------•------------- 4 b �I----------------------- ------------------------------{Title) (Plot Plan, showing size-of lot, location of system in relation to wells, buildings, etc., can be'placed on reverse side). ' FOR DEPARTMENT USE E'IONLY APPLICATION ACCEPTED BY7----------- - DATE " REVIEWED BY --P -----j%- = �[-------------- DATE ' x BUIL Alterations and/or recommends= ---------------- --=--------•----------------------------- M'---------------------- DATE--------- DIN PERMIT ISSUED•- a'tions:------ -----i------------ ------------------- --- �I' jl]: -•---------------- -----•----•------------------- '--- --- I] --------------------- -•---•--------------•----- --------------------- ------------- ----------------------------11-------------------------------:-------------------------------------------- ------------------------------------- ---------------i-----------------------•------------------ - - -FINAL INSPECTION BY: - _ -------------------------- Date---- - -c -- f SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Streetorth "C" Street Stockton, California I� Lodi, California Melnteca, California Tracy, California ES-4-2M ; Revised W-2100 �i I: