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APPLICATION FOR SANITATION PERMIT Permit No. A.1Z-1---- _ (Complete in Duplicate) — S Date Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descr'sbed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION__________________________xxmfxxm 341 So. Madera Street--_x---Stockton Owner's Name---------------------------N• I�P,e---TBylor None Phone Address----------------------------- 41 SO. Madera St. Stockton Contractor's Name-------------------D._--A'---PARRISH-__-----SONS----TNC-----INC---------------------------------------- -------------------. ----- Phone_.-9!!9___ - Installation will serve: Residence XX Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _Z____ Number of bedrooms -2----- Number of baths _1--. Lot size 50'X-110-8------------------- Water Supply: Public system $1 Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe IN Hardpan ❑ r Previous Application Made: Yes ❑ No [X New Construction: Yes ❑ No ❑ Drainage supplement. 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-----------------------------------------.______. EXiEting No. of compartments--------------------------Size--------------------------------Liquid depth-------------------------.Capacity---------------------- Disposal Field: Distance from nearest ell-_NQnC---Distance from found t'o�______12,__.__.Distance to nearest I teline_.__ Number of lines------------------------ M HLength of each line- --------------------------Width of trench_____ _________________ Type of filter material-- ---- -----.i5epth of filter material------0----_______Total length____________�3______ _________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line____.---_.-._____ ❑ Number of pits----------------------Lining material---_-------------------Size: Diameter-----------------------Dept h--------------------------------- Cesspool: Distance from nearest well----------------- from foundation_-______-----___.Lining material------------------------------------. ❑ Size: Diameter--------------------------------------Depth---------- -----------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well______________________.________-_------------__Distance from nearest building------------------------------------------ ElDistance to nearest lot line------------------------------------------------------------------------------------------------------------------------ --------------------- Remodelin and/or repairing (describe):___Alss_O- install- 114--- end- inlet---to- existing---st"j------------------ ----- septjc...tank...anQ-_--put----on redwood---cover..,--_ -------------------------------------------------------------------------------------------------------------•------------------------------------------------------------------••-------------------------------- -----------------------------------------------------------------------------------•--------------------------------------------------------------------------------------------------------------- ---- I hereby er+ify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun ordinances, to laws, and rules and regulations of the San Joaquin Local Health District. D. ARR & j INC. . Contractor (Signed) ------------------------------------ ------------------- --------------------------( : - -----------------------(Title)_E st imator. - ------------------------------------------ - --- ---------------------------------- By(Plot plan, s wing size of to+, location system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- DATE-------�:F_-� ��,c�------------------------ REVIEWEDBY --------------------------------------------------------------------.------• DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED--------------------- ------------------------------------------------------------------------------- DATE------------------------------------------------ •----- Alterations and/or recommendations----------- ---—0i -- ------------------------------------------------------------------------------------------------------------- -----------------------------------•--------------------------------------------— ----------------- -------------------------------------------------------I---------------------------------------------------------- -------------------------------------------------------------------------------- ------------------------------------------------------------------------------------ ----------- -------------------------------- ----------------------------------------------------- - ----------------------------------------- --- FINAL INSPECTION BY:-----• ------ - ---- ----------------•--------i-------- Date.--------------- --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street b14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M M1 Revised W-2100