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FOR OFFICE USE: <br /> ------------------- ---------- ---------- 41A <br /> %,cICATION FOR SANITATION Pf �/ Permit No. .41 _ <br /> -_-------------_ ------------- -----_-.__............ (Complete-in Duplicate) Date Issued <br /> _-_- <br /> --------.--- .. ---------------- This Permit Expires 1 Year From Date Issued <br /> Application is hereby mode to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance wit4,Ijffgik Ordi&lbel�,r� 5A9Arbor <br /> JOB ADDRESS AND LOCATION.............3401 So, Whiskey Slough Road, Holts CaliYOrni&............ <br /> Owner's Name...... '.d..1Kw..`WA - ................---'-' . . ................................. . .. P <br /> Address................_3401 So. Whiskey Slough Road, Holtz, California _ <br /> Owner ........ ----- .------ P - (.P <br /> Contractor's Name---------- ....._.. ......... ..._..... <br /> ------- <br /> InstallationY--- _ <br /> will serve: Residence ❑ Apartment House ❑ Commercial ® Treil Court Motel ❑ ther ❑ <br /> Number of living units: .. ----- Number of bedrooms ........ Number of ba s 1"i a --------------------------- <br /> Water Supply: Public system ❑ Community system ❑ Privets ❑ Dep to Wa able _. - . ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam Clay Loam lay dobe ❑ Hardpan ❑ <br /> Previous Application Made: <br /> (If yes,date.- I No ❑ New u on: Yes ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: Cs4ti.A4N-COM; ®f9D/oyft. <br /> /��ppf/,4� or cesspool permitted if public wer is av 11 bla within 200 fee#. d?ll IPGiNj it a qit <br /> F Arr�n� r�.s-7--►fIrfsTr <br /> nr„ / /I <br /> Distance from nearest well-AP--_-- -Di nce fro fAundation..._...___.. �j at� iahPCtNr-ke90 .AA.tjkYdh/ <br /> No. of compartments...___.-_..._..- S Q....K.x.�. .... uid depth..(RD.. ....... ....._.Capacity.f., Ra2/ <br /> Disposal P, W047t o may- t .k./ r!/•'i- o d . w <br /> (d� - . - e................. <br /> trRfk9 �.--------------------' - '`--• W.id{h-s{_#erreh-----------------........ --'-- 0 <br /> ro <br /> f 0vl11 I-- ----L!,ng <br /> ------Depth of fi material..----'--------------T.a}aL-leag+h...._...._...----------------'--------- <br /> Seepage Pit.!! Distance to ear t v� ...Distant foundation................__..Distance to nearest lot line...-........... <br /> ❑ Number of s ....._....__._... mat a ....._../Owo <br /> Size: Diameter..................._..Depth___...__.__..---....._.___---- <br /> Cesspool: Distance fro n - well ._.._.--__._ nce froation......_.___..___..Lining material..__-_. � - <br /> Size: Diamefe �/u fh................♦...._._........._........_....Liquid Capacity els. <br /> Privy: Distance from nearest well...... .........._...__...........___..Distance from nearest building.___._.._..._....................... <br /> ❑ <br /> Distance to nearest lot line----- ............................-- -'----'----......----"----"-----"-'------------'----'-............. <br /> --.._ .. ......_. <br /> �A9DRCt I ,��e [e/Iel /2!1jf� z,-y.As M,Ee/t/II�ANfie/�E•v ,-/(�.0 ll/o/ Ai 4. "Co <br /> Remodeling and or rep iring�de(cribe�:--------------- -.._..-'--"--------- ------'-- -- r `---...--'---...----------------------'--`- <br /> -------L--!4 , _JrA. �P_fe�Y�ht---�&r__ ��t7 •:_4 echi �Pd <br /> r(.-.�_✓6r`c_k�e{t_$o.he.. 1" f a.QC -..COQ__ Ptd .L-l�A L+'F�`sl�/ r t 1lttF f7 r BD <br /> V' Aii <br /> �d_ /._: .. f/°exp_Fo [ lr�.=FSS_ yir <br /> a- <br /> I hereby car+* That I hove spar d +Kis applicaffon and that the work will be done in accofdance %Ath San Joaquin Coun <br /> ordinances, State and rules end r gu +ions of Ila San J aquin Local Health District. <br /> (Signed' `^�' "- .. ...... . (Owner and/or Contractor( <br /> By:-............... ..................... ................................. <br /> .... ----- -- . -------------........c...-.................(T'i+le)------------------------------- - .__.. <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side <br /> R DEP TMENT USE ONLY <br /> APPLICATION ACCEPTED BY__q. -- - ' -- -.. ............ DATE-- 10-.4r-........................ <br /> REVIEWEDBY.......................... --------------------------------------------------------------------------------------•----.._ DATE- ----- ... -------•'-"--"'-"- -"" <br /> BUILDING PERMIT ISSUED-----------------------------------------_-----------........'-'---....................... DATE._..----...................'-....__--------•--- - <br /> Alterations and/or recommendations:- ......--. .......... .............----------------...... _---------------------------...............- -................ <br /> .......... <br /> ---------------------------------------__-------------- - .-...................... ---­------------------- -- ----yn�---�e- ---------------------------------^------------ ---t-------- <br /> FIA06PTIOY: Date.. l//91/70...- -- ............................ <br /> SAtd JOAQU HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 Wert Oak Street 144 Syoanow Street 205 W.0 9th Street <br /> 5to,kion, California Lodi. California Manteca,Collfornlo Tracy,California <br /> E.H.92M 1-6] Vanguard Pre,, <br />