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15016
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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15016
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Entry Properties
Last modified
11/28/2018 1:27:27 AM
Creation date
12/4/2017 6:35:28 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
15016
STREET_NUMBER
12601
Direction
N
STREET_NAME
CLEMENTS
STREET_TYPE
RD
SITE_LOCATION
12601 N CLEMENTS RD
RECEIVED_DATE
11/13/1962
P_LOCATION
C.W. PARSONS
Supplemental fields
FilePath
\MIGRATIONS\C\CLEMENTS\12601\15016.PDF
QuestysFileName
15016
QuestysRecordID
1692301
QuestysRecordType
12
Tags
EHD - Public
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FOR OFFICE USE; <br />------------------------ ----'-------------------=----- <br /> APPLICATION FOR SANITATION PERMIT Permit No. ................. <br /> ---------- -------- --------------- ------------ <br /> ------------------------- ------------------ (Complete in Duplicate) <br /> ------ <br /> ------ ---------------------- ----------- This Permit Expires 1 Year From Date Issued <br /> Date Issued --- <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and 'install the ork erein described. <br /> This application is made in compliance with County Ordinance'No. 549. �Aler IT <br /> tZ, <br /> LDRESS AAD LO TION-- <br /> --- ---------------- ----------------•-----•-----P ho ne.0- 7--- <br /> Owner's --------- - --- --- <br /> Address----0- I ----------------------------------------------.......... <br /> ............................... <br /> ------ -----A 1; <br /> Contractor's Name_ ..... - ------ --------------------------------------- Phone----_--------- ------------ <br /> Installaflon will serve: Residence ; Apartment House El Commercial Trailer Court [] Motel [I Other <br /> ❑ <br /> Number of living units- j--- Number of bedrooms --- umber baths -------- Lot size ------ ------- <br /> Wate Supply: Public system F Private-_- umber <br /> To Water Tablo�d--- ft. <br /> Water -1 Community system D <br /> Character of soil to a depth of 3 feet: Sand [] Gravel [] Sandy Loam [I Clay Loam Clay [] Adobe C] Hardpan 0 <br /> Previous Application Made: (If yes,date----------- No F1 New Construction: Yes [3 No E] FHA/VA. Yes 0. No [] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: i I <br /> (No septic tank or cesspool permitted if public sewer is available within.200 feet.) <br /> *' from foundation----��_o-----------Material__ 1----------------------- <br /> Septic Tank. Distance from nearest wellP-------Dista a P-'� -k7F--- <br /> No. of compartments--. ----;�!n.............Size ------Liquid dep.th___..*/------- ---------C 5city.-44- ....1.t <br /> rom ........ <br /> Dispo5al Field: Distance from nearest well-_P.........Disfancetf founclatio ...V---------------Distance toIrench nearest lot <br /> _X=7�Wiclth of <br /> Number of lines --------- __Length of.each line-----�-_ � lin ----------_---- <br /> engt ------- <br /> Type of filter ma`fe ��_,106---W---._-Depth of fi-FfeV-"�,-te'rial--- ----------Total length_____;-----6--- ._r______________•.•-__.__ <br /> --- <br /> t or F lil S <br /> ai* Se9pje Pit- Distance to nearest ell-,_--j_0_d--__--Distance from..fTunclation-J.0---.......Distance to nearest 16t line.-----_-_--"-. <br /> Number of pits------- ----- ining material__A1_4�___'_-S'ize: Di am efer- Depth_�t7Zt-------------_-_-- <br /> Cesspo.01: Distance from nearest well--------_-----_Distance from foundation .----.____---.Lining material__-.-,---_-.--_-----___--__---_..._-- <br /> 0 Size: Diameter------ ------------------------------Depth--------------------------------- ------------------Li quid Capacity---------------------------ga <br /> P ------ <br /> rivy, Distance from nearest well-------------------------------------------------Distance from nearest building-------------------------------- & <br /> Distance to nearest lot line- ----------------------------------------------------------------------•----•---------•-----------------•----------------------------------- <br /> ❑ <br /> �ing-anor repairing (describe):-------------------------------------- ------------------------------------------------------------------ --------------••-• ------••-------- <br /> ,. <br /> --------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> � ---------- <br /> --------------------- -----------------------------I—----------------------------------------------------------------------------------------------------------------------------------------- <br /> `1 <br /> ----------------------------------------------------------------------------------- ----••----•----------------•------------------- <br /> ------- ------------------------------ -------------------------------------- <br /> da' ce with San Joaquin County <br /> Yl fiiereby certify that I have prepared this application and that the work will be done in accordance un <br /> ordinaiices. State laws, an s and regulations of the San Joaquin Local Health District. <br /> r�or <br /> -------------------------- ----(Owner and/or Contractor <br /> -(Signed)------------------------- ----------------- ------ ----- - --------------------------------------- <br /> 4a <br /> _ -•n,*7 - —---------------- ------------- -------------------------------- <br /> B : ----------_--- - -- -------- -- <br /> (Plot plan, showing size of lot, location of system in relafio 0 wells, buildings, etc., can be placed on reverse side). <br /> ,FOR DEPARTMENT.USE ONLY <br /> ------------�`-DATE ----------- ------------------------- <br /> APPLICATION ACCEPTED 13Y-- _- -- - -- -4---------- -------- ---------4------------------------- 4A <br /> - � P- � - I ---------------------------------------------------------- <br /> REVIEWED BY--------------------- ---- ------------------------------------ --------------------------------------------- DATE <br /> BUILDINGPERMIT ISSUED---------------------- -----------•-------------------------•-----•---------------------------------- DATE----..-_---------------_--- ------ <br /> Alterations and/or recommendations:---------------------------------- ------------------------------------------------------------__----------------------------------------------------- <br /> ---------------------------------------- ------------------------------------------------------------------------------------------------------------------------ -------------- ---------------- <br /> ----------------------------------------------------------------------- ------I------------------ ------------------------------------------------•---------.....----------• ---------------------------------------------- <br /> -------------- --------------------- ;------------------------- <br /> ------------------------------------------------------------------------------ <br /> ------------------------------------------------------------------------------------------ ------------------------------------------------ -------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------I----------------- <br /> D -------------------------------------------I------------- <br /> FINAL INSPECTION BY:1A--- ------ -------------------- Dated <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 2M 5-62 ATLAS <br />
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