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205 West 9th Street
<br />Tracy, California
<br />FOR OFFICE USE.
<br />ss- r; C/S7 7- 47)
<br />„•
<br />APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate,
<br />This Porm4 Ex ire: 1 Year From Date Issued Date Issued
<br />This application is made in compliance with County Ordinance No. 549.
<br />Application is hereby made to the San
<br />Joaquin Local Health District for a permit to construct and install the work herein described.
<br />JOB ADDRESS AND_LACATION . -
<br />4/6 `/S- C. e. a 6 L. ( _cc • -7---,.:(
<br />Address
<br />Owner's Name ............ l'..;....f..:
<br /> ... CaR14./.4,67. ............................................................ Phone...a:el.. ..
<br /> . .--71 A--
<br />
<br />ci Y :7 / t1/4}::,4- i:s' b 1;ie t) • Contractor's Name ..t. F -
<br />
<br />.
<br />Installation will serve: Residence 0 Apartment House 0 Commercial
<br />ro Trailer Court 0 Motel 0 Other I:3' /,.//•/,',,‘,(F,',:e.,
<br />Phone /- ... ... %I? ";.F.C: Number of lie* units: ..../.. Number of bedrooms . . Number of lesi`
<br />gie.....?.. Lot size ........ /....... : .. .... I ... ,..:(/..6......›,:.) Water Supply: Public system 0 Community system 0 Private
<br />Gil Depth to Water Table .4 ..• ft. Character of soil to a depth of
<br />3 feet: Sand 0 Gravel 0 Sandy Loam 0 Clay Loam 0 Clay 0 Adobe (3 Hardpan 0 Previous Application Mode: (If yes, dote.
<br />) No !Sr New Construction: Yes 54 No 0 FHA/V; Y
<br />,e:[(31...0 N: La
<br />TYPE OF INSTALLATION AND SPECIFICATIONS:
<br />(No septic tank or cesspool permifted if public sewer is available within 200 feet.)
<br />_
<br />S.ptic Tank:
<br />x
<br />
<br />PEI Distance from nearest well..4.4'.7‘2 ..... Distance from foundation
<br /> ...... ...... Material .... No. of compartments ..7 Size 7.1 -3 ".).k .5" Liquid .depth 9./ C apacity...,V(..6...(.,.. ,
<br />Disposal Field: Distance from nearest well g5-L / Distance from foundation 44./ .. Distance to nearest lot line
<br />
<br />lig Number of lines / Length of each line /' Type of filter material ......... ic ..Depth of filter material. ../.V. . '....Total length /•••-e- / . 4' fa i
<br />.-a`c ' Width of trench 2 ' Seepage Pit:
<br />.... /
<br />
<br />K
<br />Distance to nearest well
<br /> ? ..... .Distance fr 9.511 foundation ...... 2 ......... Distance to nearest lot line .... ?...7.9 .... Cesspool:
<br />Number of pits ....... ./... Lining material
<br />/c.-€ 0C- Size• Diameter 3.F ''' Depth Distance from nearest well 2,c/
<br />/
<br />0
<br />Lining material
<br />Distance from foundation
<br />Privy:
<br />Size: Diameter ....... Depth .... . ....... . ........... Liquid Ca a i ............................ gals. \- 0 Distance to nearest lot line
<br />Distance from nearest well ....... . Distance from nearest building......................................... 1
<br />\ • Remodeling and/or repairing (describe): ......
<br />\..- ...................................................................................................... . ........
<br />— A
<br />ordinances, State laws, and rules and egulations of the S .J- quin Local Health District.
<br />I hereby certify that I have prepared
<br />this application and that the work will be done in ac ord
<br /> withSan Joaquin County ._
<br />,
<br />f%
<br />(Signed) .......... ._:.X.9. . ../....a. ... ." .... .,,..? . ,., ................................... . .... . .............. (Owner and/or Contractor)
<br />
<br />
<br />(Plot
<br />B •
<br />............................................................................. ... ........................... (Title) ...................
<br />plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side).
<br />.. •
<br />FINAL INSPECTION BY:.
<br />..... 3/11/ :if Ccpy h, „ Date
<br />130 South American Street
<br />Stockton, :I. !!/ conic
<br />Cfi 9 L .L1.0 8-59 ZM 5'6' A'la8
<br />APPLICATION ACCEPTED BY.... ... L'... -et
<br />BUILDING PERMIT ISSUED
<br />REVIEWED BY
<br />........................................................................................................... DATE ..................................................
<br />-
<br />... . ............................... DATE ........ 2...-.4-.2.zet..-^ , - ............ •Z-'-• Mterations and/or recommend'ations:
<br />.............. .... ........................................................................................................................
<br />DATE
<br />..A."1/."2,- •i ,,.7(< ,, ?,- - ..... . , k :;. -: if.- .:," .... ...... 7Z a ek*-- .. 3-4,- / ,-.. ........................................................................
<br />FOR DEPARTMENT USE ONLY
<br />ik`
<br />... ..
<br />........
<br />et r •c-
<br />SAN JOAQUIN LOCAL HEALTH DISTRICT
<br />300 West Oak Street
<br />Lodi, California 124 Sycamore Street
<br />Manteca, California
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