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APPLICATION FOR SANITATION PERMIT Permit No. A.1_f s_.. (Complete in Duplicate) s 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.___S __ -310»12-16_..E,---M - --S t-.--- Qv� Qel -_-Shopping---Geuter------- Owner's Name-------StlepheY'dc Greel]� Cren1.R...CO -*--------------- ------------------------------------ Phone------------------------------------ Address Trust Builth ! Address. l....x 90)----k S OCkton. Contractor's Name------D -A.-- AR'RISH-&- SONS-:...INC.-----------------------------t--------- - Phone-9^94]----------------- Installation will serve: Residence F] Apartment House ❑ Commercial IN Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _*___ Number of bedrooms__.___ Number of baths -------- Lot size . ____ ___ 9 t____________________-___.______ Water Supply: Public system Ig Community system C] Private E] Depth to Water Table ___— ft. [ . Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[M: Hardpan ❑ t `W Previous Application Made: Yes ❑ No EX New Construction: Yes ® No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: Q (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 None lOx C C Brick Septic Tank: Distance from nearest yll--- __________Distance from foundation---- _________Material_____ -__ ___ _ ____ _______________. Ix No. of compartments__-L_____ b"x �" " - 100 Gal Sizes- 7 Li usd de th g Ca aci Disposal Field: Distance from nearest wellNon ____.Distance from foundati n___z2-t_______.Distance to nearest1gt�ine_5____.____. ` [ Number of lines_______l___ Length of each line____�5!_________________Width of trench______-----___________-_-__-___...-_ Type of filter meteriarl.�n___Rk____Depth of filter material____ $p___________Totaf length------7s f___________________________ See�ge Pit: Distance to nearest well.....N�ne------Distance from foundation---20_t______.._Dist�nce to nearest lot li�e._}-0_t________ Number of pits-----I--------------Lining material_C'---C. Br-J-- *e: Diameter-----33 ----------Depth------95-------------------- Cesspool: Distance from nearest well_________________Distance from foundation------------------- material-------____-_-------______--_-_._.___. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_______________________________________--. ❑ Distance to nearest lot line------------------------------------------------ -----------------•---------------------------------------------------------------- -------- aF�F Re odeli g ar,�/ r re airs (de tribe}:____Sstem- Far ung-oecupi�d-_unit___and__p�rooe�__unit_*________________ 'ote of uii ► 5� toilets and wash basns; ------------------------------------------------------ ------------------------------- -- --N©------liv-ix> ---units-,-_R_..AL-------------------------------------------- ------------------------------------------------------•-------------------------------------------------------- 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 ules a d reg tions of the San Joaquin Local Health District. (Signed)---D -- -- -A-------- - ---&- S-- - ---------INC ---- -----------------'-----------------------------------------------(��on+roc+orJ Estimator ---------------------------------------------------------------(Title)- - - - - -------------------------------------------•- (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 APPLREVIEICATION WED BY--ACCEPTED BY----------- ------------------------------ DATE r r` f° DATE - BUILDING PERMIT ISSUED-------------- ------------------------------ -- ----------------------------------- - -- ---- -------- ,.. ------------------------- Altera ions and/or i commendations: --------- -- -------- ---- ------------------------------------------------------- I.) -- �:_,_ f--- -------- ------ Q.a-�-�. -------------- --------- - ..- o- -`'� _.__ n ----------- -------------- t! I r � � FINAL INSPECTION BY:--------4::;A0"/`---------------------------------------- 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 E5-9-2M 5.51 Revised W-2100