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APPLICATION FOR SANITATION PERMIT Permit Ng & _ <br /> (Complete in Duplicate) y <br /> . Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION----------328---E;---- Qu-izjeAV.- ---Manteca,-..-Cal-iJ -. <br /> Owner's Name-------- - -_--------------------------------------------------------- <br /> . .�--- -------------------------------------------- Phone-----57_T-_,2_3-------------- <br /> Address-•--------------------aa mia----_......•--------------------------•-_.....•----------------•------------------------------------------------------------------------------•---- <br /> Contractor's Name-------------l Delta-------------------------------------------------------------------------------:---------------------------------- Phone-----j--j9-5j-j------------- <br /> Installation will serve: Residence :E] Apartment House ❑ Commercial ❑ Trailer Court [] Motel ❑ Other ❑ 4 <br /> Number of living units: __X__ Number of bedrooms __2___ Number of baths 1_____ Lot size 55x-1bQ------------_________________________.____ i <br /> Water Supply: Public system ❑ Community system © Private ❑ Depth to Water Table _=42-'ft. �a <br /> Character of soil to a depth of 3.feet: Sand�]c Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay-E] Adobe ❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑ �No ® New Construction: Yes ❑ No Ek <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well_________________Distance from foundation------------------- Material_________________ <br /> ex 161 Ing No. of compartments--------------------------Size--------------,•----------------Liquid de th.---.---------------------Capacity INI <br /> Disposal Field: i ' � P------ -----------------------� <br /> Distance from nearest well.___-5Q__._.._Distance from foundation_____-(}_ Distance to nearest lot line--------- !__. <br /> ] Number of lines--'-l---------------------------Length of each line---------2-5-'-- _------.Width of trench----------2_A-------------"------ <br /> Type of filter material _..--rook-------Depth of filter material___..-,c-,e.k------.Total length___.-___._2s�+_____________________ <br /> Seepage Pit: Distance to nearest well-_--------------------Distance from foundation-------------------Distance to nearest lot line-------__.______ <br /> ❑ Number of pits--- ------------------Lining material-----------------------Size: Diameter-----------------------Depth---------- ---------------------- <br /> I - <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-----------------_Lining material---------------------------.._._____- <br /> gals-❑ ----__Depth----------------- --------------- -Liquid CapacitY---------- --- <br /> Privy: Distance from nearest well----------------------------------'- --.Distance from nearest building.--------------------------------------_- <br /> ❑ Distance to nearest lot kne------------------ -------------------------------------------------------------------------------------------- <br /> ------------- <br /> Remodeling and/or repairing (describe):________ZXl-salling___25_'___addl i0al-.-3_ei-Ch_--dra•1n----------------"-.-----_____ <br /> ` ---------------•------------------ -------------------------•------------------•-------------------------------------•-------------------------------------- <br /> F a <br /> f - <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordjinances, State laws, and rules and;regulations of the San Joaquin Local Health District. <br /> (Signed)----------- •---=-D_elta...Se_f3_t_ C.__Tank__-.er ----- (Owner and/or Contractor) <br /> 8 Pix ' W z't ��- - ----------------(Title)---------G2T1.Mg_r-.------------------------------ <br /> (Plot plan, showing size of lot, location of system in re ation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br />` APPLICATION ACCEPTED BY-- --------------- --------- ---- ----------------------------------------------------------- DATE =---- ---------- -------------•------------------- <br /> 1 <br /> REVIEWED 13Y DATE-- =------------------ <br /> PERMITISSUED-------------- ----------- ----------------- ----------------------------------------------------- DATE_.-. <br /> Alterations and/or recommendations_______________._____. '"' <br /> -----------------------••-•----- =-- ...------------ ••---•---- i <br /> ---------------------------------------"------------------------------- -------------------- _ <br /> ----------------------------------•--- <br /> -------------------------------------=---------------------------------- --- ---------------------------------------------------------------------•---------------------------------------------- -•----------.---------- <br /> --''--- - --- --- --------------------------------------------------------- ef------------------------- <br /> FINAL INSPECTION BY _______ _________ <br /> - ------------------------ <br /> Date ` <br /> 114- 9� SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Streat 132 Sycamore Street 814 North "C" Street <br /> ...Stockton, California " Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 10-5!%Rovised W-2100 <br />