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FOR OFFICE US/E: �" � t j4 f P ------------------------------------------ -------------- APPLICATION FOR SANITATION PERMIT Permit No. .1.7 �`. .. ---------- ------------------- ------------------- (Complete in Duplicate) _.___._____---- This Permit Expires 1 Year From Date Issued Date Issued .z.. 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. San Joaquin River Club, Tracy area,. JOB ADDRESS AND LOCATION----1ZL,__2._3oc---- of-- alae--Dr-ive--4Aid--Shastsa-------------- Owner's Name----------Ra' ---Ce.--I.vuis---------------------------------------------------------------------------------------------------------- Phone.................................... Address----------------------S Contractor's Name.......ThC--DAy..&-N3£Gf T..Se�t.j --`t'8tt __5 rvilmi -----------------------------------------.... Phone.466- $4 .............. Installation will serve: Residence MC Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: A-_ Number of bedrooms ----11. Number of baths A -_ Lot size ------50.t._$_-IX1-.-___•_______________________ Water Supply: Public system ❑ Community system EC Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe MC Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No J;X FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 14 Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------.Material_-------_---___-----_-__------___---.--_----___-. Wsting No. of compartments-------------------------Size.------------------------------Liquid depth--------------------------Capacity---------------------- Disposal Field: Distance from nearest well..l00!------Distance from foundation.10t-._....._.Distance to nearest lot line...0...__... 12 Number of lines-----Xl,. .__ ____________Length of each line__ -- Width of trench-----24n..--------------------- Type of filter material__8*pt_Rk------Depth of filter material-------];9-1t--------Total length........................(3Qt.___..._.__ Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line-.___._____-__--- Eii sting Number 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------------------------------------------ f0 ❑ Distance to nearest lot line------ -----------------------------------------------------------------------------------------•--------•-------------•-------------------- Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------------------------------------------- --------------••------------------------------------------•---------•----------•------------------------------------•-•---------------------------------------------------------------•------------•----------------------- 11 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 a -Joaquinca Health District. (Signed)-------Tho--DAY---&--NIGH-T--Sep-tic-.Tank--Ser-vkae--2------ ------ -----------( Contractor) -E ---- - -------------------------------- By:...........................................--------------------------------------- T ---------- ----------------------------------- --------- (Plot plan, showing size of lot, location of system in relation q'wetfs, buildings; e+ can �e placed on reverse side). of FOR DEP TMENT USE ONLYJ APPLICATION ACCEPTED BY-------------------------------------------------------------- DATE.........<.1�. l�' REVIEWEDBY----- --------------------------------------- - ----_------------_- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED---------------------------------------------------------------- ------ DATE------------------------------------------------------------- Alterations and/or recommendations----------------------------------- ----------_----.....------------------•----- ------------------------------------------------------------.......... --------------------------------------------- ------------------------------------- ------------------------------------•-------------------------------------•-••---•---•------------------•-•-----••---•--......----------- ---------------- ------- -----------------------------------_------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------- ------_- -------- -- ... .----------- ------------------------------ ------ FINAL INSPECTION BY:... ---------------------------------- Date ' ' ------------------------- -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasolton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California 96 9 REVISED 8-59 3M 3-'63 F.P.CO.