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APPLICATI N FOR--A-NII TION PERMIT Permit f4o. <br /> (Complete in Duplicate) <br /> r� <br /> w Date•issued -__` -� <br /> Applies+ion is hereby made fo`-the San Joaquin Local Health Districf for a permit to construct end® instal! the work herein described. <br /> This application is made in coinpliancwith County Ordinance No. 549. <br /> r I; � � s <br /> JOB ADDRESS AND LOCATION_____Z3a9.-5..._Go1aen Caste ` <br /> -----------------------------------------........................................-..------ <br /> Owner's Name.-- " -W• -Faracas - - Rent�x+: . 4rs.-B. .. tiara Frank3 in Ph. ]��. x6855 <br /> Ph n <br /> 97 Ac c a Av. North Sacramento <br /> --.....-- •-• o e..... -----•------ <br /> 5 <br /> Address...................7 --•--•-- - ----------------------- <br /> Contractor's Name--Delta <br /> h <br /> -------••--------------------------------------------------•------------------------- --------------------­­--------..---- Phone-- - <br /> Installefion will serve: Residence IN Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> s <br /> Number of living units: Number of bedrooms ---1. Number of!� <br /> baths 1•.-_ Lot size �__acreg__.._.,.•____•__••_ �_ i <br /> Water Supply. Publics stem <br /> y ❑ Community system ❑ Private ® Depth to Water Table _= ft _ <br /> Character of sail to a depth of'3 feet: 'Sand ❑ Gravel ❑ Sandy Loaf❑ Clay Loam ❑ Clay❑ Adobe[N HardpanE] <br /> Previous Application Made: Yes ❑ No [3r New Construction: Yes E] No ❑ ' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ' <br /> (No septic tank or cesspool permitted if public sewer is available within 204 feet.) <br /> Septic Tank: • Distance from nearest well__.._ 9______Distance from founda#ion_.__.10_f.......Material.......C��ment <br /> 3 x ; 1 1. <br /> ® No. of compar#monis..... .................5ixe_. -------.-_•_-!- & '� <br /> $ .---Liquid depth---�••--........3-----Capacity--�--''�--- <br /> Disposal Field: Distance from nearest welt.................Distance from fAndation------------_-------Distance to-near est lot line_____ --- <br /> JKI S t ing Number ofl`tines------------------ ----------------Length of each liil,e..............................Width of french----------•-__-- <br /> Type of filter material---._.. - <br /> ----....•......:..Dep#h of filter m#aterial........... Total -length_.--------••_-•_-• a <br /> Seepage Pit:I Distance to nearest well----- _,:_pistance from Jncla+ion--.1�-p___.D'stan a +o nearest lot Iine_...�!.p,•,. <br /> ® } Number of1lpits_____Z -----.`iiining material----x'ACk- ---:Sze: Diameter.-: ---��----------.pepth__.-1 �........._.!.._-•_-- <br /> Cesspool-: " ` 'Distance friom nearest well-----------------Distance from foundation..............::....Lining <br /> atorial... <br /> _.._.........___...Diam � ................ <br /> . <br /> eer.............-••--••-----5xe ---____-- th__.__-.__...._.... .. -- Liquid specify g Isl - ------ <br /> Privy_ <br /> Distance from nearest well-_t.............................. <br /> ..... Distance from nearest building-__........ <br /> ❑ ' .. <br /> Distance to;nearest fat line...........:—..__..--•--••-----..__.._------ - ----------- ........... --•—•.................. <br /> Remodeling and/or re airin9 --_ - tangy t0 reP.•••-••• caved in <br /> --- ------- <br /> ----taCk - -------- <br /> ....•.. •--•--•._.._------- <br /> I <br /> II --- r <br /> .....................................•-•-•-...-•------•----•--•--•---•-- - <br /> •••.. <br /> --•---•--•--••--•-•-••-••-••---••--• ---•------. ------------••....................-------------------------------••••••.....------•------- --- --- --..._..---- --.----- --- <br /> I hereby certify that I have prepared Phis application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and 'regulations of the San Joaquin LOCM Health District, <br /> (Sign t -�. wne J <br /> --......--••--.-----......--- <br /> _.... . ....----•----------- or Contractor) <br /> !By:.-._..•............._NO--;-------- r = - ""' - (Ti+le]_ - <br /> (Plot )Ilan, showing size of lo+ location of Sys+e:ri in relation to wells, buildi gs, letc., can be placed on reverse side). <br /> FOR DEPARTMENT VSE ONLY <br /> APPLICATION ACCEPTED BY;?,............ DATE_ <br /> REVIEWED BY---------------- -------------••-.._----I. .........' _..... --- -- DATA � <br /> 'f <br /> BUILDING PERMIT ISSUED-------' III <br /> "�" -.._._.:............... _ - ' ............- DATE- ......iliF <br /> ..................... <br /> Alterations and/or recommendations......................................................... <br /> s' -•------ <br /> . .... .._..__..__ ........•._...__.....__.0.......... <br /> ......................••--^---•--••--••. --•---••--.: ......... ...............................................:.......0..................... <br /> . <br /> ....................................... <br /> -----•._......... .......... ................... .......__..__......................._...._..__._...__.....__..__...__I)�.__....• ...._..__...... — - <br /> li R� <br /> ------- -i� Date-� ------------------- , <br /> r <br /> I <br /> FINAL INSPECTION BY:� r ��J �� . <br /> ... ............................... <br /> f SAN JCAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street �' 300 West Oak Street 13F Syeamere Street orA "C" Street <br /> Stock}on, California Lodi, California Man+acs, California Tracy, California <br /> ES-9-2M Revisod W-21 DO I: <br /> - r <br />