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FOR OFFICE USE. ---------- APPLICATION FOR SANITATION PERMIT Permit No. -------------------- - -22-!------- ------ -- (Complete in-"Duplicate)4 -1�p-------------- Date Issued ------- ____M_M_V_mm I This Permit Expires 1 Year From 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. 5' 1 JOB ADDRESS AND LOCATION--------545 ANTUM t STOCKTON ---N.---------------------------------------------------------------------------------------------------------------------------------------- Owner's Name----------------------•----------------- AYR ROSMHAL 464-7b97......-- ------- ---------------------------------------------------- ------------------------------ ------------- Phone--------------------- ....... 1 lA7 Greeley ; Stockton Address..........................................................------------------------------------------------------------------------------------------------------------........................................ The DAY & NIGHT ST SVC. Contractor's Name----- ................................I----------------------------------------------- ------------------------------------------------------ Phone.AO!7�8".............. Installation will serve: Residence C] Apartment House E] Commercial E] Trailer Court [] Motel [] Other [3 dUP19x Number of living units: 2 h -70t I 190---_____________________________ -------- Number of bedrooms -2--- Number of baths ...2-- Lot size ------ -------- Wafer Supply: Public system U Community system E] Private F] Depth to Water Table kp-- ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam El Clay E] Aclobelg Hardpan 0 Previous Application Made: (If yes,date------------------) No E] New Construction: Yes E] No MF FHA/VA: Yes El No D 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.-501--------Distanrjj frjtn,�,;w Cmerete 2 1 , ----10-a-------Nuarial----------------------------- ME No. of compartments---- --------- ----------Size---------------------------- uid depth__ _____.___________.I-----Capacity---- ------------------- Disposal Field: Distance from neares well-,39---------Distance 'from foundit.)8.,-- Qbisfance to nearesj_JQLine.... ....... Number of lines-------- line--_---_6 0- Mi --- ------------Length of each -------------V --.Width of trench-------------------2-4*----------- Type of filter material -A--Depth of filter material-------19----------Total length------------160 f, -------------- Seepage Pit: Distance to nearest well_.- ----------._-_.Distance from foundation-------------------Distance to nearest lot line--/,.. ......... El Number of pits_ . _-____ Lining material__ . ____________.Size: Diartiter_ -_ -._ _.__..___Depth________ -__- _(._:. �� Cesspool: epth----------------- --- Cesspool- Distance from nearest well-----------------Distance from foundation-------i------------Lining material________-_--._.___._,__-____:_---_ ,'� ❑ aterial------------------ ------------- 1771 Size: Diameter------------------------ ------------Depth-----------I--------------------------------------.-Liquid Capacity-------------------------•--gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building_:-__----_--___---_________--_______... ❑ uilding.-:------------------------------------ F-1 Distance to nearest lot line---------------------------- ---------------------------------------------- ---------------------------- ---------------------------- Remodeling and/or repairing (describe):------- ------- _PqAp;X moved--i ----- -----n--* -----------------------------------I-------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------- ------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------I------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that ave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sfafe'lav, mules and regulations of the San qu Local Healthn District. (Signed)------- --- ------------I------------------------ Contractor) 9EP=C--TANK-SERV1CF—-------------------------------- ------- ----- ----- - Miner Ave_, - HO.6-3841 By:...9P�4!�F!-M------------------------------------------------------------- ------------ --- ky------- -------------------------------------------- -- ---- --------- �Tille) (Plot plan, showing size of lot, location of system in relation to ells, buildings; 6 can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_.._.-_.:_ ... DATE------- -----;7/--------------fm----------- REVIEWED BY---------------------------------- -- -------------- -- --------I------------------------- ---------------------------- --------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------ ------------------------------------ Alterationsand/or recommendations:---------------------------------------------------------------------------------- ------------------------------------------------ --------------------- ----------------------------------- ---------------------------------- -------------------------------------------------------- --------------------------- ---------------------------------------------------------------- ---------- -------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------ ....I--------------------------------------------------------------------------------------------- ---------------------------------- --------------------------------------- ------------------------ -------------- -------------------------------------------------------- ---------------------------------------------------------- FINAL INSPECTION BY:----------15514 Date--..---- ------------------ -- --- ------------------------------------ --------------------------- SA rJOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.00.