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FOR OFFICE USE: -------------------------------------------------- APPLICATION FOR t --------------------------------------------------------- SANITATION PERMIT Permit No. --------------------------------------------------------- (Complete in Duplicate) --------------------------------------- This Permit Expires 1 Year From Date Issued 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...:._z!�5_._bh -S Lathrop Caf,-------------------- --------------------------------- Owner's Name Bertha--MfLy--Reynolds PhoneA9-!-----5 -49-x-•0--- -------------- _ -------------•------ Address............. aha Mrs. Nona Sleeth 132b N. Htanter -------------------•---....------. --------' ------------------------------------- Contractar's Name--•----••---� a Septic_Tank Sery .cep Ing, --------------------------•------- Phone_2.. �-1 9 Installation will serve: Residence [2 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __X..__ Number of bedrooms -2--- Number of baths ___3 _. Lot size ...__ O,--X--X00-------------------------------- Water Supply: Public system ❑ Community system ❑ Private [4 Depth to Water Table __2Q_ ft. r Character of soil to a depth of 3 feet: :Sand ❑ Gravel ❑ Sandy Loam ® Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No [N New Construction: Yes;K] No ❑ PHA/VA: Yes ❑ Nod] 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-------------------------------------...---_._... E41Sting No. of compartments----------- - -----------Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well..----------------Distance from foundation....................Distance to nearest lot line................. ECISting Number of lines-----------------------------------Length of each line------------------------------Width of trench------------------------------------ Type of filter material------------------------- of filter material-----------------------Total -- length------------------------------------------ Seepage __.____________--__----____-----___--____See a e Pit: Distance to nearest well-_�fls-P--------Distant e from foundation_�Px _ .Dista`ce to nearest lot line_._. tP_____ Number of pits------ ----------- Lining material.----roCk ) loll' max. - - - -----..Size: Diameter------ 5_.-.-------Depth_._.------------------------------ Cesspool: ----._ Cesspool: material , Distance from nearest well_________________Distance from foundation._._________.--_---.Lining material•__.-____••___-,__________._________ ❑ Size: Diameter--------------------------------------Depth-----------------;----------------------------------Liquid Capacity----------------------------gals. v_ ' Privy: Distance from nearest ,well________________________________________________Distance from nearest building------------------------------------__--- �• ❑ Distance to nearest lot line----------- -------------------------------------------------------------------------------------------------------------------------------- Remodeling -------------- ---Remodeling and/or repairing (describe): aaC ---t-o----exi-a—ng---s,sy-61-em------------------------------------...... --•--•--•--------••---------------------------------------------- ------------------------------------------------------------------------------------•-------------------------------------------------------- -----------------------------------------------------------•-•-----------------------------------------------------------------------------------------------•------------------------...------------------------------ ------ I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws,-and rules and regulations of the San Joaquin Local Health District, (Signed) -Delta Septic Tank Serv. ' Inc•__t_________________________- - •--•------------- - (Owner and/or Contractor) B : Perry.-_Warthan------------------- - Title Gen. Mgr. --------- - - - -- -y � � ) ' - - ----------------------------------------- - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FORD RTMENT USE ONLY APPLICATION ACCEPTED BY--- F -/X- -------------------------------------------- DATE------- ----- ---- ----------- REVIEWEDBY--------------------------------- ----------------------------------------------------------------------------------------- DATE-------- - BUILDINGPERMIT.ISSUED----------------------------------------------- ------------------------------------------------------ DATE------------------------------------------------------------- Alterations and/or recommendations:--------------- -- ------ -----•---- -- ------------------------------------------------------•------------•------ --- . -•-----•-••-•-------------------------------- -------. .--------------------. -----•----- _- ------------------------------------------------------------ ------------------ -------------------------------------------------------- ---------------- f' X,* FINAL INSPECTION BY:--------W, ------------------------ Date--------- .... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California [9.9 REvl96O 9.59 F.P.co,SM 6.60 '