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APPLICATION FOR SANITATION PERMIT Permit N _ _ I (Complete in Duplicate) 2 -� ��a�►� Date Issued 1 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. Save-Mart, 3310 E. Main Street JOB ADDRESS AND LOCATION.--- -•----------------------------------------------------------------- --------- -------I—•---------------------------------------------------------.------ Shepherd & Green, Genl Contrs 9-9017 Owner's Name ---------- ---------- ------------- --- -- --------- ---- - --- -- --------- Phone. Address______________________ American Trust Building# Stockton N,, San Joaquin St, ) -.....------•--------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Contractor's Name_____________________________PARRISH INC. 0 +� 9907 - ---------------------------------------------------------------------------------- Phone-------•-------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial-'q Trailer Court ❑ Motel ❑ Other ❑ 50'Number of living units: -------- Number of bedrooms -------- Number of baths 2___-_ Lot size ----—-tX�------------------------------------------- Water Supply: Public system [Community system El Private ❑ Depth to Water Table -40- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe N Hardpan ❑ Previous Application Made: Yes IN No ❑ New Construction: Yes ❑ No ❑Supplementary drainage TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material_.------------------------------------ ---__-.__. Exioing No. of compartments--------------------------Size--------------------------------Liquid depth-------------------------.Capacity----------------------- Disposal Field: Distance from nearest welt_________________Distance from foundation--------------------Distance to nearest lot line_______________ ExlEting Number of lines-----------------------------------Length of each line-----------------------------.Width of trench----------------------------------- V' Type of filter material------------------------- of filter material-----------------------Total length__________________________________________ ! ' V Seepage Pit: Distance to nearest well_._N� �__-____Distance`�fr� {oup ,ation_____�'2_______.. is, nce to nearest lot line,�___20____.__ Number of pits---- ---------------Lining materia9 - -----'------ ...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---------4----------------------------------------------------------- ---•---------------------------------------------- -- --- ------------ Remodeling and/or reair (describe):___*This is supplementary. drainage to axtai�IXg the: firs r .. system insta led during the first '�ui�dirig pro ec at•- 6o --banter.-----The leach drain is under blacktop, hence--is---riot-- effectiTe ;--------------------•--------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 1 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 San Joaquin Local Health District. PARRISH INC.., Contractor (Signed) ---------------------------------------- --------------- --- --- ---- --- ------------ - -- ------------------( �' ) BY: r� D_0�ft (Title)_$St [i----- tOr (Plot plan, showing size of lot, location of system i relation to wells, l` Ings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------- ------------------------------------------------- DATE-----------•- Z- s REVIEWED BY----------------------------------- ----------------- DATE---------- � � --------�------ -------- ------------------------------------------- - -------------------- BUILDING PERMIT ISSUED--------------------------------------------------•------------_------------------------------------ DATE---- Alterations and/or recommendations-------------•---- ----------- ----------------------------•------------------------------•-------------------------------•---------------------------------- -------•----------------------------------------------------------------------•-------------------------------•---------------------------------------•----------------------------------------------------•----------------- ----------------------------------------------------------------------- ----- ------------------------ --------------•----------------------------------------------------•-------• -------------------------------------------------------------- -------------------------------- ---------- --------------------------------- FINAL INSPECTION BY:- -------- ----•-- ------------- Date.- 1 j� f- 4d `T Z -- . Y---------------------------------------------------- f` 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 E5-9-2M �o-52 Revised W-2100