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rvX urrlc.c uat: , - ----- -- --------- -- --------- ` PLICATION FOR SANITATION Pf ��l Permit No. . _--- ----------- - -- ---------------- -- (Complete-in Duplicate) Date Issued ....._.:�J"�o.�s ....... .... __..------_--.-____--_.--- This Permit Expires 1 Year From Date Issued L 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 witlt&T9'ke0tdiflbeah _rtorbor JOB ADDRESS AND LOCATION.............3401 So. -Whiskey Slough &Oad! Holtz California_.__--_.... L+� .. --- '---- Owners Name__.._P�Il�J-._1r1.,r__..HQ..l.BR!Q..rt.,-13,s--.STI`•------------------'---------'-----------------------------'------------ Phone................-.......... ------' Address.................'3-.4-.01 So. .Whiskey Slough... __Holt, California Contractor's Name-'-------'-Owner -_-•----.......----'---"--'---------'-----------------'-------------------------------......... Phone........____......--._.. Installation will serve: Residence ❑ Apartment House ❑ Commercial KI Trail Court Motel ❑ ther ❑ Number of living units: .. ..___ Number of bedrooms __.._... Number of ba :rail I �._......................... Water Supply: Public system ❑ Community system ❑ Private ❑ Dept to Wa aftCharacter of soil to a depth of 3 feet• Sand ❑ Gravel ❑ Sandy Loam Clay Loamay dobe❑ Hardpan ❑Previous Application Made: hf yes,date__-__._.___. I No ❑ New u Ion: Yes ❑ FHA/VA: Yes ❑ No ❑ 1. TYPE OF INSTALLATION AND SPECIFICATIONS: /� Co*V,A4,'"-COM Pr.�rc P•fr f gp ti # or cesspool permitted if public war is av J ble within 200 feet. ! It�f� rQGi,yl+c;a C�/f ,PF /Mr4, �,�qq j�'`j�r� / � sr.�i +f�9��-1fIT, Ir .�:a- Distance from nearest well-��..-Q--.- . -Di nce from foundation----.__._ __.lyt afyial6ty. No. of compartments.__.... ......... Si Q..._X.x.fr._.. uid depth_(RD- -._-_ -_.._..Capacity.1-,SbR. Disposal a �,/}� O �.�' .Tc/ A/`f O ,ed . . `1 aRrNltoM(` Baas_-------------------- - -'-- Wid+h-eC-trema 1_----------•-•---•-......------ fav/1 I--- ------- --------Depth of `1Amaterial........-------------T h-----------------------....w------- s Seepage Pitz Distance to ear t -.... ......_.Distancec 1 foundation.............__Distance to nearest lot line__-__---_--.___.. ❑ Number of s ..............._-Lin ng mat a ---_.------__-- _. Size: Diameter..........-----_---.__-Depth___------------_--------------- Cesspool: Distance fro n well______________}� ante fro oyy�ation-----------__..__..Lining material......................._.._.__...... ❑ Size: Diamete -- ---- ---- //D th -/------ .-..-.. -- ...Liquid Capacity. - — gels. LPrivy: Distance from nearest well_..,_- ___iii------------------------------------Distance from nearest building-_-__---__-.__._.._..—................ ❑ Distance to nearest lot line----- ----`-----__---'------------_--------....----------------------"-----._-'-......"'--'-----`----------- CIApr4Cr e Leffe,e l/jPF,PeA, 14 0,Mrc.�vF,WWdEry ,e./IroexdPrj.tts., Co. Remodeling and or repyiring1de cribe�:---.-`----.-- - y _TM.---•`-_-_.._-----.............. Jr �. ao - yp'`' - `-- -----------1'-'-`f� ' i--�-P.!?'.e�n° -M--��-- ��'�9�-�--c...,��Pl'�/ �-/[>:9.`I R---IQ,�tIfL.,IC!.�:rte...- ,�pQ fC�cd v6re-_ ..e rBd+M__- A45dfi /.I, v-lljq 1� Wt6o�rlt_^-�t2cl oEI hereby cer#i/y That 1 have reparapplicaffon and that the work will be done in accofdance 16if San Joaquin Counts ordinances, State I ws, and rules and r gu tions of the San J aqui n Local Health District. (Signed -i-.lam.:..---`...-------'- - - — - - - - - (Owner and/or Contractor) r_ .__(Title)-----------'----- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). R DEP TMENT USE ONLY APPLICATION ACCEPTED BY_- ___...__---_ ___ _ ______ _______ PM_ --------------- DATE_.. .. .- � REVIEWED BY.. -- - - ...--_--------------' --------- -------- _ --- -...___ ......._.... ...... --------- ----- DATE_- -----------•-------------------•---••---- BUILDING PERMIT ISSUED------------- ......-....-.........._.....-----...... -..........................--------- DATE_.........--------------------------------------- Alterafions and/or recommendations---- ...................... -----------...----_..........---------------------.......-...................---------............. r- ------------------- - - -------------------------------------- . --'-------- — -------------- - -- - - -----------_-------------- s. w v 7 p FINA IN PEC TIO Y:..- - - Date-1111.9.1-70---- ---------------__......"------------- SAt! JOAQUIN LOCAL HEALTH DISTRICT 1601 F.Xaadlon Ave. 300 West Oak Street 124 sycamore slraef 405 West 9th Street Stockton,California Lodi California Manteca,California Tracy, California E.M.9 2M 1.67 Vanp.rd Press