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4200/4300 - Liquid Waste/Water Well Permits
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16031
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Entry Properties
Last modified
12/3/2018 10:23:23 PM
Creation date
12/4/2017 6:10:44 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
16031
STREET_NUMBER
28407
Direction
S
STREET_NAME
CHRISMAN
STREET_TYPE
RD
City
TRACY
APN
24808013
SITE_LOCATION
28407 S CHRISMAN RD
RECEIVED_DATE
06/26/1963
P_LOCATION
D ORLANDO
Supplemental fields
FilePath
\MIGRATIONS\C\CHRISMAN\28407\16031.PDF
QuestysFileName
16031
QuestysRecordID
1690365
QuestysRecordType
12
Tags
EHD - Public
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FOR OFFICE USE- <br />-------------------------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> (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 County Ordinance No. 549. <br /> JOrADDRESS`ANP,LOC�TION .l t-PA 1 <br /> Owner's Name --:��-- -----r--------------------------------- -----•------••----------------------------------=----- - __.------------------=------------------ <br /> 't, Phone. <br /> ------------- <br /> Address ��- . ---- --- ---------- --------- --------------------------------------------------------------------••-•---------•-----•-•--•--------------------- <br /> Contractor's Name. ---------------------------------•-----------------------------.•---. Phone_._._- -D----- -----•---------- <br /> Installation will serve: Residence El Apartment House ❑ Commercial Trailer Court E] Motel E] #h�6 er ❑ <br /> Number of living units: __ Number of bedrooms _~_ Number of baths -------- Lot size - _ <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table j ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel 0 Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ r <br /> Previous Application Made: (If yes,date---- ------ -) No V New Construction: Yes No ❑ FHA/VA: Yes ❑ No;N <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted-if public sewer is available within 200 feet.) <br /> Septic T Distance from nearest well_________________Distance from foundation--------------------Material--------------------------------------------------- t <br /> No. of compartments--------------------------Size--------------------------------Liquid deptil--------------------------Capacity------------------- ` <br /> Disposal le - Distance from nearest well._ -_____Distance from foundation..s-. Distance to nearest lot Iinp___. __0_..__. <br /> Number of lines.___.______._._- Length of each line_ '�Q___-____r�__._._.Width of trench-- ______________________ yi <br /> Type of filter material_ Depth of filter material----1e---'1F------Total length_____.5_,Z�__________________________ <br /> Seepage Pit: Distance to nearest well._10_ ``______Distance from ou ti n__4.0_.._____Di to ii? to nearest 1 # 'ne------ _ ..1 <br /> Number of pits------ -----------Lining material__- iameter----- -- ---Depth_-.-1.- ----------:---------is <br /> Cesspool: Distance from nearest well_________________Distance from oundation--------------------Lining material---,---------------------------------- <br /> i . <br /> ❑ Size: Diameter-----------•--------------------------Depth--- ----------------------------------------- ------Liquid Capacity---------••-•------------ gals. <br />-..� ._� <br /> Privy: Distance from nearest,weli____ _--------------------______-____-----Distance from nearest building--------------------------------- <br /> ______._. <br /> ❑ Distance to nearesf'lot line------------------------------------------------ -•----------------------------------•----------------------------- --------- -------------- �Q <br /> Remodeling and/or repairing (describe):-- --------- -------------------------------------•-•-----------------------•-----------`------------------------•----------------------------- • <br /> '-----••-------------------------- ---•------------------------------------------------------------------------------------- ------------------------------------------------------------------------ r . <br /> yt <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State aws, and rules and regulations of the San Joaquin Local Health District. " <br /> (Signed)--- ------- --=r- ---------- ------------------------------------------ -------- - ------.(Owner and/or Contractor) <br /> y <br /> BY:....------------------------------------------------------------------------------------------------------------------------------(Title)---------------- ---------------------------------------------- <br /> (Piot 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------------ -----------------------------------------------------p--------------------- DATE <br /> --- <br /> BUILDING <br /> EWED BY-------------------------------------------------------------- ------------ DATE �-- - <br /> � � to <br /> BUILDING PERMIT ISSUED --------------- --------- DATE------------------------------ ------------ <br /> Alterations and/or recommendations----------------=------------------- -------------•--...-..--------------------------------------------------------------------------------------------------- <br /> ----•---------------------------------------------•-•------------=----------------------------------------------------------------•--------------- ------------ ---------•------------------------------------- --------- <br /> ------------------------- ------------------•---------------------------------.------------------------------- ----------------------------------- <br /> --- <br /> ---------------------------------- <br /> ------------ -- ------------------1--------------------------------- ---- ---- <br /> 3 <br /> FINAL INSPECTION BY:. ------- ---- - Date_ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stocktonr California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 9-54 3M 3-'63 F.P.CO. <br />
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