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APPLICATION FOR SANITATION PERMIT Permit No. .1-_ .�`~-.. ppyy,, r� (Complete in Duplicate) ti Date Issueda Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descr-shed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION----3 -_3310�-12-1b---E M�_ ..5_t;.---B,S]Q-Sey_ejt... Y o-OpIng---Gente�•---- •- Owner's Name--------Shepherd-& Gretna Gen_ . !O_ontrs-•---------------------------------------------------- Phone------------------------------------ Address American-- Trust Building...(_3p% Stockton - Contractor's Name_-.. _D'- A.ARRISH---& SONS f INC. *---------------------4P Phone_9"!QbO'j.- Installation will serve: Residence C] Apartment House ❑ Commercial Pq Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _*__ Number of bedrooms*__-___ Number of baths**___ Lot size _15_�-_-'�_-_5C t t Wafer Supply: Public system Community system C] Private E] Depth to Water Table -------40 Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 9 Hardpan ❑ t ■` Previous Application Made: Yes ❑ No EX 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 yll--_NOne_-Distangefrom foundation---10-- -------.Material---.0 C Brick 00 Gal "X72" No, of compartments_-____________--_-_____5ize________________ e _ ___-Ca Capacity---- --- ----Liquid depth---�-9----------- - P tY------ - ---•-- ----- Disposal Field: Distance from nearest weIlN—ne____.Distance from foundation---22 t---__---Distance to nearest gt�jine_5-_._------. Number of lines_______)___ ___________ --Length of each line-_-_-7�f________-_-____-Width of trench----2z# Type of filter materially-----Rk-----__Depth of filter material----18-------------Total length------751--------------------------- Seepage Pit: Distance to nearest well__--_NonL`------Distance from foundation...2�t_-_..._-__.Distance to nearest lot line_ -Iq 2-----_. Number'of pits-----�---------------Lining material C lc --C-_Br4 • Diameter-----33 p Z 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------------------------------------------------•--------------------------------------------------- iM�F Re oder g and/ r re air'n (de tribe}:____S,ylstem for _un-occupied-_ pr_QgQ�G�__��t� 'otaf of u�i.i _. toilets and 5 wash basins,------------------ --- -- ----•--•----•--•-----•-------------------'----- ------------------••----------------------------------------------- Nrt.._... --- * _ .-------------------------------- ----- -----------------------------------------------------...----•--------------------------- --=----- --------------------------------------------------------------------------- ---------------------•--------•----------------------------------------------- • I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances a laws, and rules and reg tions of the San Joaquin Local Health District. DA & S N s INC.(Signed)--- ------ ---------- - ---------- --- - ----------------------------------- ------------------( +�l'vf'Contractor] B (Title) Estimator (Plot 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 - S2 V ; BUILDING PERMIT ISSUED --- ------------------------------ DATE------------------- Altera ions and/or r commendations:-- -.__------------ ---------------- ------- Q `� -------------- d� ----------------------------------- --- w o$G FINAL INSPECTION BY:--------+�j0`----------------------------------------- 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 f