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15852
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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15852
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Entry Properties
Last modified
12/2/2018 10:08:35 PM
Creation date
12/4/2017 5:27:55 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
15852
STREET_NUMBER
2305
Direction
S
STREET_NAME
CHEROKEE
STREET_TYPE
LN
City
LODI
SITE_LOCATION
2305 S CHEROKEE LN
RECEIVED_DATE
5/17/1963
P_LOCATION
EDGAR RICHARDS
Supplemental fields
FilePath
\MIGRATIONS\C\CHEROKEE\2305\15852.PDF
QuestysFileName
15852
QuestysRecordID
1687279
QuestysRecordType
12
Tags
EHD - Public
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FOit OFFICE USE: <br /> II �- �I:m6y� y <br /> -------------------------_-----------------_------------- $ <br /> .APPLICATION FOR SANITATION PERMIT Permit No.,_/.----------------------- <br /> .....I <br /> (Complete in Duplicate) <br /> Date Issued <br /> ------------------------------------------- This Permit Ex fires l Year From 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 County Ordinance <br /> 49. <br /> � e W � 7 �• <br /> l 5 <br /> JOB ADDRESS AND LOCATION.--__- - ------ <br /> A0 -- ___-----•------ <br /> Owner's Name....... .- �� ° Phone. <br /> ------------ <br /> ------------------------------- <br /> Address. '...............•-------------------..................................................... <br /> Contractor's Name.. --a.: -----------------------------'_..-..................-•-....-------- Phone.-......----•--•------------------- <br /> - -------------------- <br /> Installation will serve: Residence 0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _1______ Number of bedrooms _a--_ Number of baths I__-_ Lot size ........... <br /> Water Supply: Public system ❑ Community system ❑ Private Q Depth To Water Table -_4:f?ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy'Loam M Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: ;If yes,dote--------------------1 No ® New Construction: Yes 20 No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if;public sewer is available within 200 feet.) IAN' <br /> Septic Tank: Distance from nearest well__e'f�------Distance'from•foundation---_I b.___--__.Material___ _ ____ _ <br /> ___ �4" ! <br /> No. of compartments------—---------------- r_--9-fi---c---------Liquid de th------- --- - --------Caaci � O J <br /> Disposal Field: Distance from nearest well __4EQ-------Distance from foundation___1_b------------Distance to nearest lot .......... <br /> �] Number of lines________ ___________________ Length of each line___.._.PO'__ Width of trench._�"4/-____-____-______-.___ <br /> d I <br /> Type of filter materia _ __ _____ __Depth of filter material._._ __._._____._Total length..I�.-_._•_••.•......___•__..•_••._-__ <br /> Seepage Pit: Distance'to nearest wel______________________Distance from foundation--------------------Distance to nearest lot fine--•_•_--.---__-. <br /> ❑ Number of pits-_-- <br /> "---------------Lining'material--_-_-_-•------.------Size: Diameter-----------------..._.-Depth----------•-------------------... <br />;1 Cesspool: Distance from nearest well-----------------Distance from foundation-------------------- material.................................. <br /> ❑ Size: Diameter.----------- -----.Depth-----P----------•-------- ---------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------_-----Distance from nearest building.._•.--._-_._-_.__•._..._-____-_--_-_-.-. <br /> ❑ Distance to nearest lot line------------------------------------- -------------------••---•-•---...----•-••-----••---••-------•-•------------------------------------------ <br /> Remodeling and/or repairing (describe): ........'........-•------------------------------------------------------------------•------------------------ <br /> ------------------------------------------------------------------------------------------------------------------ <br /> �-----k------------------------__..._. <br /> --_--------------------------•-•----•-••------------------------ <br /> r •------'---------------'---------------------------------------'---..-.----------------•••--•--•----------••-----------------------------•------------•---------•--••----• <br /> -- ---------••_-•---------------•-•--------•---•-•••-----------------------------------------------------'-----»..........._.._.._....._.--------------I---------------•-------------------------------- <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulationrA regulationof the San Joaquin Local Health District. <br /> (Signed) ------------------------------------------Owner and/or Contractor <br /> By:------------------------ - -- - ----------Title)...-.----------------- :..^^'_. .-.. <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 DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -------------- -------------------------------------- DATE----- f 3 <br /> REVIEWED BY---------------------------- <br /> --------•------ -----------------------------------------------•----- �•-----------------------. DATE.-----------•-------•------•-------------------------------- , <br /> BUILDINGPERMIT ISSUED------------•-------------- -----------------------------—-------------------------------------- DATE--------------------------------------------- --------------- <br /> Alterationsand/or recommendations:------------------------------------------------------••-•-----------------•---------•---------•-•-•---------•---•----.--.-------------------------.._...- <br /> ---•----•--•-------• .......•-- :...• - r.... --- ----- <br /> --- ---------------------------------------------------- --- ------------- --- - --- .. ..----- - <br /> FINAL INSPECTION BY - ------------ Date--- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wert Oak Srreet 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED a-55 2M 5-62 ATLAS '` <br />
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