Laserfiche WebLink
FOR OFFICE USES <br /> 'PLICATION POR SANITATION PF 11T <br /> Permit No. . .I --y •�•• <br /> (Complete-in Duplicate) Date Issued <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the Sen Joaquin Local Health District for a permit to construct and install the work heroin described. <br /> This application is made in compliance wit4 fhTgl� 1Q dipartb :j�'Marbor <br /> JOB ADDRESS AND LOCATION ..... .._. 3401 SJJo..�SJhi,�ey Slouch Roads Holtz...Calif ornia <br /> Owner's Name_...�I(a...`"J.e....HQ1.6:KQ.rtt.4.s.. J2'*............... Phone........................ <br /> So. Whiskey Slough Roads Holt Califoi�ia . ............... <br /> Address...................... . ..... ....................... . <br /> ... .. ...... ............ ..... <br /> Contractors Name.. _........... .._._............................. . <br /> .... .._. . ........ . ._.......... Phone..._. ................_.......... <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ® Trail Court Motel ❑ ther <br /> Number of living units: . .. Number of bedrooms . <br /> Number of ba s 2- a ........I................ <br /> Water Supply: Public system ❑ Community system ❑ Private ❑ Dep to We able ft <br /> Character of soil to a depth of 3 feet' Sand ❑ Gravel ❑ Sandy Loam Clry Loam lay dobe❑ Hardpan❑ <br /> No ❑ New u .on: Yes ❑ FHA/VAS Yes E] No❑ <br /> Previous Application Made: Ii f yes,dote- ,r.Co �f��ORO- <br /> TYPE <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ��f <br /> �If IQt:N rar.N Q� <br /> pti 4 or Cesspool Permitted if public er is 1I ble within 200 feet qq .41C <br /> I(��, T <br /> �p� / t/et�riaii[OiN JPP0V tM*Q7Al4 J��IT <br /> ,��� ,F D stance from nearest wei!,90 Oi nce from I foundation Ce aci /.�0��� <br /> No. of compartments . . S .-.X.7 uid depth GD - W <br /> `, r r carr e................. w <br /> D sposal �� I <br /> ttRiMZeK .4s>Qc .... ... .... . ...... �e"4+f' >f enc <br /> 7r0 I.. Depth of fi mater,al . .. ...............T�laL�eoglh......................................... <br /> " ma h T - <br /> Seepage PitC Distance to ear t ... Distan foundation...................Distance to nearest lot line............ <br /> Nuranc of s Lin ng met a .'. Sae: Diameter.......... Depth... ...... ...................... i <br /> Cesspool: piste,rP r-, n well..._ .. ante fro ��ll <br /> ton . ..... Lining <br /> d Capacity gels. t, <br /> ❑ Size: Diann W ih q P ty............. <br /> �r <br /> Distance from nearest building......................................... <br /> Privy: Distonce from nearest well... . <br /> ks <br /> ❑ Distance to nearest lot line ......�................................................................ . . ... .. ..-. <br /> ('s►p RC r tc — Le fPK ���/i��ReM M �.Nlrc lwft'<< 'M.c ....... <br /> d Fk Nei .wT <br /> p , ,{ co• <br /> Remodeling �hd or rnp�iirin �dofcriVt,: <br /> cw !•>' FO �d /- ��.%n o �1.� ..- CPQ.. Via! <br /> q <br /> Ir.M �E..� P - Ir , .. <br /> �-6. IC2 /..R&.A.0..3fAptmv <br /> N. .3.0O. �r f.�--Vii /.1..�la�r , �„<.��,�,. z� � <br /> h+ ..J)ho/l�v P.-fR+ .+Gb��I�.^ �'�r f f /.folC. ++f done I hereby cert jr that 1 have�eparW% ai olf the n and San J taquinhat hLoealkHeallt�Didr ct� acco dente sfith San Joaquin Coun <br /> ordinances, State I s, and rules and r gu <br /> (Owner and/or Contractorl <br /> - <br /> (SigA. <br /> ned)... .. <br /> e. <br /> ........................ <br /> .. <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings. etc., can be placed on reverse side). <br /> (FOR DEPAATMENT USE ONLY <br /> ✓ ..................................... .. ....?...7. .. . .. .......................... <br /> APPLICATION ACCEPTED BY.. DATE.. . ......................................... <br /> REVIEWED BY .... ...... ..... <br /> .......... . .. .. .. ............................. <br /> BUILDING PERMIT ISSUED........ .................................................................. <br /> ........................... <br /> Alterations and/or recommendations:., .. ... ._ .......................................... <br /> J ........... ....................................................................... ....... , <br /> ........... ............ <br /> ,' ..... ....... . ......................................•...... ......... .................. <br /> i <br /> v{, O Z; <br /> Date 111191, 70......... ........ .. ....................... .. . <br /> FINA INSPECTIO J Y: <br /> SA JOAQUIN LOCAL HEALTH DISTRICT <br /> X00 West Oak Street 12♦Sycal Street 205 West 9th$11ee1 <br /> 1.01 [.Moselle"Are. Trat <br /> 51.eklen,California till CaNfil la Manteca,California y,CalHernle <br /> E H.9 2M 1.67 vo"gvard P'" <br />