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APPLICATION FOR SANITATION PERMIT Permit No. -- -- .- ,, ° 5 (Complete in Duplicate) 3/ il"i �,j 11 Date Issued ----- - !-.. 01 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-----------331- __E_„ M #.n treet� _Stockton - -- -- -- --------------------------------------------------------------- Owner's Name---------------------------------------------J__. --Corbin Shepherd (Shepherd & Green4cine---979017--------------- - - ------------------------------------- Address--•-------•------------•. American Trust Bui.ldi -------------••------------------------------ Phone �~ �0 Contractor's Name PARRI,SH IN C. •---•--------------------------------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths __2--- Lot size ----BB- �ckto Qeq area fi- -------�-2_fl ------------------------ Water Supply: Public system N Community system ❑ Private ❑ Depth to Water Table Ya-. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ] Hardpan ❑ Previous Application Made: Yes EC No ❑ New Construction: Yes ❑ No ❑ Replacement TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septico�Tank: Distance from nearest well -__None--_Dista R jroT fojpdation_6-T-------------.M terial-CC Brick rxNo, of compartments--------------------------Size-- - tt.-- 1t Liquid depth.__- -.-----_-_-_-.--Ca acit �2 0 G�Zs 5e' deep- -- p y-••----------- ------- Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line_---.---.--.----. Eilsting Number of lines-----------------------------------Length of each line..............................Width of trench----------------------------------- Type of filter material-------------------------Depth of filter material------------------------Total length--------------------------_--------------- ` Seepage Pit: Distance to nearest well----- ----_-Distance from foundation--------------------Distance to nearest lot line----------------- o E)asting 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--------------------------------- ❑ Distance to nearest lot line--------------------------------------------- - -••--------------------------------------------------------------------------•-------- Remodeiin and/or repairing (describe):__- Build_Ing was built over septic tank., We will _--------------------------------------------------nd alp construct a new- one outside the viii-linzig---arid---ub-6----- • --------------- ....-------------------------------------------------------------•--•------------------------ ------------- -- existi drainage system. . - ------------— ---. .-------��---—-� r-------—-�-��---�-� -- ----.....---=�-�"--�! ---�_- _ n-.l,_- ___ . _ r !. F. f-r----f _.r z +-= 1 E =--------- - 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 regula ns of the San oaquin Local Health District. PARRISH INC;. (Signed) w.. -r --------------------------------------- By: -------------------- --------------- ( ss�i +a Contractor) B . Title Estimator y ( ' ) ---- - - - - ------------------------- ------------------- (Plot plan, showing size of lot, location of system.i relation to wells, buildings etc., can be placed on reverse side). z 4 POR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY- -- ----------------------------------------------------------------------- ------ DATES.------------------------------------------------------ REVIEWED BY----------_---------- ---- ---- ---- -- ------------------------ ------- .--. DATE BUILDING PERMIT ISSUED--------------------•-••----...--------------------------------------- ------ -------------- --------- Alterations -------Alterations and/or recommendations--------------------------- -------------=-----------.......--------------------------------------------------------------- ------------•---------... -•--------------------------------------------------•-------------------------------- -----------------------------•--.------•------------------------------------•--• -----------•--•--------------•------------••---------- ------------------------------------------- -----------------------------------------------------------------•-----------------------------------------•------------------------....----------•----------------•------------ ---••------------------------------•--------------••-------•--•--------------------...----------------------------------•----•-------------------------------- ---------------------------------------•------------------- -------•-----•-----------------------------------------------------•-------------------------------------------------------------------•----------------------------- -------------------------------------------- FINAL INSPECTION BY:.-------X_4q?,�Arf------------------------ Date_- -----------------"�f iY-4 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteeet, California Tracy, California ES-9-2M 10-52 Revised W-2100