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FOR OFFICE USE: r <br /> ---- --------'---'--Y------r'- �- <br /> -- -- '....... --------- - .- 'PLICATION FOR SANITATION Pf�11T Permit No. .�t :.ra/ <br /> F� <br /> - ---- --r ----`---------- ---------------- ----- --- (Complete-in Duplicate) <br /> ._............. This Permit Expires 1 Year From Date Issued Date Issued __ ' <br /> Application is hereby made 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 with iygl$ Odipd bgah 5 9arbor <br /> JOB ADDRESS AND LOCATION-.-._--.-- 3401 So. Whiskey Slough Road f Holt, California <br /> -------- <br /> - ---------------------- <br /> Owner's Name---- NdTlif,9---W1---TlAiRi OI`�hs... ----­------------------ --- ....................... ............. Phone------------------------------------ <br /> Address.................3401, So. Whiskey Slough Road, Holt , California <br /> • ---- . .---------------------•------------------- <br /> Contractor's Name Owner --------- Phone----------------------------------- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial NJ' TraA Court Motel ❑ ther ❑ <br /> .�. <br /> Number of living units: -- ----- Number of bedrooms -------- Number of ba s e --- --- -------- ----- ---------- ----------------- <br /> Wafer Supply: Public system ❑ Community system ❑ Private ❑ Dept 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: (If yes date------------------- No ❑ Ne:e <br /> u ion: Yes ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: Gs�k`,µre-C.-M Vf Wft R01 <br /> gpt `fa c or cesspool permitted if pubs* wer-is av tl ble within 200 feet. �4#p, �xm �iN��riv ovt <br /> Distance from nearest well-A-0.____ _Di nce from f undation.._ __ at rlalgClN'.Ao %A".t9/Yrf11[1/�-�t�-6! <br /> (� No. of compartments---_--.--- --.'---- S K.77- -- ---- -- uid depth -0------- ------- Capacity. <br /> Disposal ; <br /> fps oRl -.. -=--� _t <br /> e <br /> J/ v h I Depth of fi material--------------- -------T h------------------------------------------ O <br /> Seepage Pit. Distance to ear t �----- --------Distant e foundation..............----- Distance to nearest lot line..--------------. <br /> ❑ Number of s --- �.Lin ng mat a Size: Diameter Depth ' ' <br /> Cesspool: Distance fro n well -------------j� ante fro Vafion. _ ___-.-..-.... ..Lining material_._.....__--_--_.-..--..-__.-.....Size: Diamete - -------- ----- ----V�� <br /> Dth------------.... ------- -- ----------------------Liquid Capacity- ----------------------..gals. <br /> Privy: Distance from nearest well_-_... -------------------- - ----------..Distance from nearest building.__..__._------------------------ ------ <br /> Distance <br /> ___Distance to nearest lot line _... <br /> g� �9 C� p g ��� Le ffieR 1/j 0/�.M A4,0,MtkW41 , <br /> Remodeling dor re irm e cube --------- - --- ------- ---.-.-------------_-- •_--- '-- <br /> l _ <br /> �--!-`��b,rf -`-� r�°_C��S�M�Ml`$-a �CFI�c`r��. -���f°C���-�9r1�� 6P �lt`�9�!'�r� ��4 <br /> d <br /> ---_ <br /> I hereby certtYy that i have epar d tKs applicatfn and that the work will be done in accoFdance ti6ith San Joaquin Court <br /> ordinances, State I ws, and rules and r�egu tions of the San J aquin Local Health District. <br /> (Signed)-- 1 ------ -`--(-�%-------- '--'- ---------------------"--- ----------- ------ --------------(Owner and/or Contractor) <br /> = ---------•---------------=----- ------------ --- f---------------- -_(Title)---=-------------- -------- -------. .... . ....... <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> OR DEP TMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- - --- ------- C.i- ----------------------- -------------- DATE l <br /> -------------------------------- <br /> REVIEWED BY------------------------- --------- ---------------------- ---------- -----------------------------------------._ DATE------- ------ <br /> BUILDING PERMIT ISSUED-------- -- ----'--------------------------------------------------------'-------------------------- DATE----------------------- - <br /> Alterations and/or recommendations:-------------' _--- ---------------- --- ---------------------------------------------------------------------------- <br /> ----------------- -- - ------------------------ - ---------------------- -- --- -- --------------------------- .._.. ---- ---------.------------------------------------------ --------------------- <br /> ---------- ----..... --- '- --'- -------------- - ---------------------------- -----------------------------------------------------'------- ---------- -- ---------------- ------- <br /> ------- <br /> - --------------------- <br /> ---- ------------------------- _ 4eZ' <br /> NP <br /> vQFI NA I1'IO Y: - Date..�j//,9L-7 - ... - <br /> SA JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.tMaxelton Ave. 300 West Oak Street 124 Sycamore Streetl <br /> 205 West 9th Street <br /> Stockton,California Lodi- California Manteca,California Tracy,California <br /> E.H,9 2M 1-67 Vanguard Press <br />. i l <br />