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8513
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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CLARK
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3601
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4200/4300 - Liquid Waste/Water Well Permits
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8513
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Entry Properties
Last modified
8/21/2019 10:10:05 PM
Creation date
12/4/2017 6:27:03 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
8513
STREET_NUMBER
3601
Direction
E
STREET_NAME
CLARK
STREET_TYPE
DR
City
STOCKTON
SITE_LOCATION
3601 E CLARK DR
RECEIVED_DATE
02/11/1957
P_LOCATION
ROY MONK
Supplemental fields
FilePath
\MIGRATIONS\C\CLARK\3601\8513.PDF
QuestysFileName
8513
QuestysRecordID
1691644
QuestysRecordType
12
Tags
EHD - Public
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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in_DupGcate) � ..._.__.- <br /> _ Date Issued .___!,C3 <br /> Applica-lion 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 /> JOB ADDRESS A LOCATION--------------------------------/ '� , '� I7g - !'7(� <br /> 3fto r i1=•� } '' z1 <br /> '- Ru , <br /> � _______ _______________ <br /> Owner's Name------ -•- _0.y:- •---------•--- q - <br /> L ------•----------- ---------------------- ------ -------------------- -------- <br /> - F` Phone__Address___._ -- <br /> l�/ j '"- - f3a}� �Y -------•------------------- - <br /> Contractor's Name- =`5� � J ----------------------------•-- <br /> -------------------------•------------------------------------------------ <br /> -- ------------ --- <br /> Phone-----• _ <br /> Installation will serve: Residence Apartment House ❑ Commercial{[] Trai er Court''❑ Motel ❑ Other_ - a <br /> - ®=�-� <br /> Number of living units. . <br /> ------ Number of bedrooms'`Number of baths __-- Lot osize'-_ <br /> ---a- �P_..__.. <br /> Water Supply: Public system ❑ Community system-4❑ Private [f��Uepth to Water Table' <br /> - --�ft: <br /> Character of soil to a depth of 3 feet: Sand ❑ .Gravel ❑ Sandy Loam ❑ lay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: Yes ❑ 'No A lel Construction: Yes to ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 fe t.) + <br /> Septic>01 <br /> T Distance from nearest well QO_ <br /> Dist e fr m ka d lion- --� ---_ --Mater•al--� <br /> No. of compartments...- - <br /> Size_ <br /> _Liquid depth Ca pacify. ^� <br /> Disposal F d: Distance from nearest well/00 "--Distance from foundation _ �_ I <br /> _..__.__.Distance to nearest lot*�ine____ ________• �y <br /> Number of lines__ -""-.- _Igen th of each line_____ _-.--.Width of trent y_ __________ <br /> Type or' filter material-�Z -�.- epth.of filter materiaf_._-- - Q --`--------- <br /> ------ <br /> Total length - •-- ----- ------- ----------- <br /> m <br /> eepage Pit: Distance to nearest well---------------- -----Distance frbfoundation_____.___-_______ <br /> Number Distance to nearest lot line____'.._.____--. <br /> ❑ Dumber of pits---------- %-- ------Lining{material---------------------- Size: Diameter--------- ------Depth--- ---------------- <br /> Cesspool: Distance from nearest*well----------------- ounon.--___.- -.Distance from foundation <br /> `.Lining materialOt <br /> ❑ Size: Diameter------------- ------------------------Depth---------- ---- <br /> - -------------------------- <br /> Privy: Distance from nearest well- ------ --- --- - <br /> ---- Liquid Capacity----------------------------- <br /> _._____-__ ------------_Distance from nearest building <br /> ❑ Distance to nearest lot line_...___--.-_"--.__---_--- w._r <br /> ------------ <br /> Remodeling and/or repairing (describe):---------------- <br /> ------------------------------ T, <br /> ----------- -•------=-------- .----- <br /> - - <br /> ------------=-- <br /> _ -- ------------- <br /> ---•---------------------°------------ <br /> ,� :-- ----------------I---�------------ .- <br /> - -------------•---•------------------------ ---•-----------•-----------------------------------f--.--- --------------- -- <br /> I hereby-ce�aify that I have prepared this application and that the work will be done in accordance with`San Joaquin County � <br /> ordinances;,'Sfaie:laws, and rules and regulations of the San Joaquin'Local Health District. ° <br /> (Signed)- <br /> ------ -- <br /> _(Owner and/or Contractor) <br /> By:----------- ••------- - -•. ---- <br /> ------------------------ --------- ----------- ----------•-----------•-----------(Tale)--------- ----- - <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> v FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY__--_--___- _ <br /> ----••----•----•------------------------- <br /> REVIEWED BY DATE_ -- -------•------------------ <br /> BUIL� . - -- ---- ---------------"----- ..------ ------- DATE_-------- <br /> DING,'PERMIT ISSU-ED______-.----"---_- "-- <br /> Alterations and/or recommendatigns•--------`` ----- ................ DATE------- --� - ----------------•--------•------------ <br /> -- ----- <br /> `-------tn <br /> - - -- -- -- --- <br /> FINAL INSPECTION BY: .. ` <br /> - - - Date----- <br /> SAN JOAN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street <br /> Stock+on, California814 North "C" Strea+ <br /> Lodi, California Manteca, California Tracy, California <br /> ES-j 145446 A7WDpD <br />
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