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we �• r irk APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 3- ��`'b ry Date Issued_ 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. JOB ADDRESS AND LOCATION-._ --3310»12-16---E,---aln-_Sta---R4,Q_8e-Y-elt---Shopping---Center------- Owner's Name------- Shepherd- &--Greeria--Gen_ c04ti <------------------------------------------------------ Phone------------------------------------ Address._-------------American --- Building-__(_3Q , Stockt.Qn.-----------------------____-- ------------------------------•----•------- Contractor's Name------D�- A.- I�-.RISH_--&--SONS,---INC---------- ,------------------t - -- Phone_9!9'0_7 • Installation will serve: Residence ❑ Apartment House ❑ Commercial IN Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ ___ Number of bedrooms_--_-_ Number of baths ------ Lot size _ 5.7__T ___50�_________________________________ Water Supply: Public. system Community system ❑ t Private ❑ Depth to Water Table ________ ft. 4 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe IM: Hardpan ❑ ; `` Previous Application Made: Yes ❑ No ❑( New Construction- Yes ® No ❑ ` TYPE OF INSTALLATION AND SPECIFICATIONS: V (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest ell-_-Nona_Dsan kfromfoundation___1'01-___--_-Mate rial____C_ CBr1ak nM � No, of compartments SizJ" X2 -------------Liq 'd depth---�9 -- -------Gapau#y1 5,-Pal Disposal Field: Distance from nearest well -one Distance from foundation___22_t--------Distance to nearest tjine_1r t_.._.____. 99 Number of lines____--1__- Length of each lin e-----718_ .Width of trench 2�_______________________ ` Type of filter materially„__ Rk________Depth of filter material---- ----------------Total length------75 ___________________________ It See age Pit: Distance to nearest well-----None_ Distance from foundation___-----------Distance to nearest lot line--;P-- Number- ine-_;P� Number of pits--___._____________Lining materialC C Bri-ze: Diameter_____33M___ -------Depth-------- 5-?---- --- ------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material____________________________________. ❑ Size: Diameter-------------------------- ----------De th----------------------------------------- -Liquid Capacity Privy: Distance from nearest well------------------------------------------------- from nearest building--------------------------___-__________- �� a ❑ Distance to nearest lot line----------------------------------------------- iF�F Re o eli g arr,,��/ r ro air'n {de tribe):__-_SVBtem for Un-►Occupiad unit_ and___pr_Q�p � j, � 'o of of - i u ii>� e------toilets---and--_,- wash-_basins Nat---living--unts --------•------- = ----------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•--------------------- ------------------ + I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances a laws, and rules a d reg tions of the San Joaquin Local Health District. D. A &--S N --- SNC. ----------------------------- - ( contractor) (Signed) - 6 - ------------- B - ---------------------------------------------------------------(Title)-Estimator (Plot p n, of lot, location of s em in elation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------• �' DATE REVIEWED BY-------------------------------------- � - DATE------ - BUILDING PERMIT ISSUED----------- ��-------------- --------------------------------------------------- DATE------------------ Alte,a ions and/or r commendations:- ----- -------------- ----- -------------------- -------•----------- ` --------------------------------- ------------------- . ' - - ---------- - ---- --- ---- - ------- - - ---------- _ __ _______ _ ____ " 4----------- H ----------------------------- - J�.'�---_ _ "__ •___ _ V FINAL INSPECTION BY: ' d` -------------------------------------- Date------------ --- ------------------------------ 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 8-51 Revised W-2100 i