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ii V1`00, APPLICATION FOR SANITATION PERMIT Permit KA 4 (Complete in Duplicate) yy 5 Date Issued .11J_Z 2 Applicafion 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, North Side of C . C. Blvd, JOB ADDRESS AN LOCATION.._ lst -lew house bef_ ore enteri3ig Country Club Golf Club„ . Tracy', Construction Co. % E. W, Tracy Owner's Name-------------------• ------------------- -------------------------------------------------------------- -------- Phone__2F 730 ------ ------ ----------- --- Address....--------_-----��5_.Cxford Street ConfFactor's Name------- PAiSH INC----- Q7 ------ one Installation will serve:. Residence N Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ii Number of living units: 1-_-_ Number of bedrooms ___2__ Number of baths _3____ Lot size 1160 1x1201 Water Supply: Public system 4 Community system ❑ Private ❑ Depth to Water Table -------- ft. r Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [?�X Hardpan ❑ Previous Application Made fl Yes ❑ No E4 New Construction: Yes r] No ❑ s TYPE OF INSTALLATION 'AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet. ll None Concrete Mix Septic Tank: Distance from nearest w�-_------�---.-__Qcs+a�c0e�flom fours Odl�^___--_-.-.M t r�+al-.___._,__________________ Ki 4 o �, � 1� No. of compartments".- -- ---------Size-- 5-�- p-------Liquid t eptly----------- - -----------Capacity----- Disposal Field: Distance from nearer .well-_NOne Distance from foundatjo� � Distance to nearest�V,,line_________________ Number o-i lines___..___ _ _ LL �l I3:n---R-k__Length of each line_--:____�---�ff------------Width of trencFt,_00- Type_.of�jfilter_material___- 2-,-•=----------Depth of filter material===----------`-`-----Total length:--__---------- ------------------ Seepage Pit: Distance- to nearest well_.--------------------Distance from foundation -------------------- to nearest lot line-------_.________ ❑ N lumber,;of pits----------------------Lining material------ ------------Size: Diameter-----------------------Depth--=--------------------------- Cesspool: Distance from nearest well-_--------------Distance from foundation--------------------Lining material_______--_-.__-__._._ ❑ Size: Diameter -----------------------------Depth----------------------------------------------------Liquid Capacity----------------- gals. Privy: Distance) from nearest well-------------------------------------------------Distance from nearest building ❑ Distance to nearest lot line-----------------------------------------------•-----------------_- Remodeling and/or repairing (describe):_______ -_-Note extra depth of filter;also 10"- ID concrete ------------ ------------------ dr 3 ri pP leach drat ra. li i ------------------------------------------------------------------------•-------------------------------•------ --------------------------------------------------------------- Ij -------------------------------------------------------------••-------------------•-------------------------•--------------------------------------------------------------------------------------------------------- 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 mules and regulations of the San Joaquin Local Health District. I (Signed)-----------------------------------� H PARR ISH INC. -------------------------------------- 46 r contractor) By:.... �l ==- --- Title Estimator (Plot plan, showing size of lot, location of system in rel tion to wells, building etc., can be placed on reverse side). a. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------------- DATE . �. -- REVIEWED BY --------------- ----------------------------------------------------- -------------------- ------. DATE BUILDING PERMIT ISSUED-Ji--------------------------------------------------------------------------------------------------- DATE Alterations end/or recommendations__________________ ___________________ •--- i. ---- -------------------------------------------- Ii ----------------------------------------------------------- ----- •---------- •------- -------------------------------- --------- -- ---------•-------------- --------------- ------ ------------------------- -------------------------------- FINAL INSPECTION BY: "----- Date-------------- � '�7 ._ . ------------------------ �� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100 � � s