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69-75
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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COOLIDGE
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4200/4300 - Liquid Waste/Water Well Permits
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69-75
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Entry Properties
Last modified
2/14/2019 11:07:41 PM
Creation date
12/4/2017 7:45:58 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
69-75
STREET_NUMBER
428
Direction
S
STREET_NAME
COOLIDGE
City
STOCKTON
SITE_LOCATION
428 S COOLIDGE
RECEIVED_DATE
02/14/1969
P_LOCATION
R.D. MORROW
Supplemental fields
FilePath
\MIGRATIONS\C\COOLIDGE\428\69-75.PDF
QuestysFileName
69-75
QuestysRecordID
1699652
QuestysRecordType
12
Tags
EHD - Public
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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> i ' r - --- -------------- Permit No. <br /> (Complete in Triplicate) <br /> Date lssued7:/'T9 <br /> -- --------- <br /> This Permit Expires 1 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 <br /> described, This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations. <br /> f <br /> _C_)8, S •�6A\� ----J_�-�ti�-._: __:. CENSUS_TRACT <br /> r JOB ADDRESS/LOCATIONyy__ - <br /> Owner's Name . ' -,l-1QX(b" - _ . --- ----- 11 <br /> one <br /> 4.. <br /> Ph - <br /> Address -- 1 w (rW\C}1 - 4�Q ----------------------------------- CitY --------------------------------------- ----- --------------------•------- <br /> f Contractor's Name -_ � --------------------- -------- --License # `Opsll Phone . <br /> E. <br /> Installation will serve: Residence Apartment House,❑ Commercial:❑Trailer Court '❑ <br /> Motel ❑ Other ------- ------------------------------------ <br /> Number of living units:'---A----- Number of bedrooms a--_---Garbage Grinder NO---- Lot Size `1Q ---` ----------------••---- <br /> # Water Supply: Public System-and-name -�. !�' ----------------------- <br /> --- . - ------------Private <br /> k Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam -❑ ;Clay Loam'❑ <br /> f Hardpan ❑ Adobe TD( Fill Material 10---- If yes;type ------------- -------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on' reverse side.) \� <br /> l NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,} N <br /> PACKAGE TREATMENT [ ] SEPTIC TANK[ ]' Size------------------------------------------------ Liquid Depth -------------------------- q� <br /> Capacity -----------V------- Type -------------------- Material------ --------------- No. Compartments ------------------ <br /> �:X <br /> i Distance to nearest: ;,Well ------------------------------------Foundation ---------------------- Prop. Line -------------_---.---- <br /> k LEACHING LINE [ } No:!of Lines ---- -=----------- Length of each line----:----------------------- Total Length ------ --------------------- <br /> F <br /> 'D' -Box"-___1 '- Type Filter Material --------------------Depth Filter Material ------___---------------------------------- <br /> Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line ----------------------- <br /> SEEPAGE <br /> ----------------- --SEEPAGE PIT [ Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No <br /> Waterf Table Depth --------------------------------------------------Rock Size --------------- -:-------------- <br /> r <br /> Distance to nearest: Well ----------------------------------------Foundation --- <br /> ----------------- Prop. Line ---------,------------ <br /> - 115 t• coy <br /> REPAIR/ADDITION(Prev. Sanitation,Permit#---_----..---------------------- -- -- Date ----------�---�a�--�-�---- =--------1 <br /> Ir <br /> Septic Tank [Specify Requirements)} 0 }N T ---- 1doq <br /> -- -tX: <br /> f <br /> 1 /_�1�y Y <br /> Disposal Field (Specify Requirements) - -=- k ------ <br /> D 4 SSfIIJ <br /> ------------------ ------ ----------------- ------------ ------------------------------------------------ ------------------------------------------------------- <br /> - (Draw_existing and required addition on reverse side) <br /> - ... <br /> Z— <br /> ' I hereby certify that I have prepared this application and that the work will be done-in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the. San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the Following: <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person. in such manner <br /> t as to become ubje t orkman's Compensati. n laws of California." <br /> 1 -----------•--------•---- ---- Owner <br /> Sig -1 h'-�-c------- <br /> BY ------------------------------- ----------='"Title ----- ---- ---------------------- ------------- ----------------------- <br /> (If other than owner) <br /> FOR DjPARTMEk4T USE ONLY <br /> APPLICATION ACCEPTED BY - -- ---- --------------------------------------------- ----------------- DATE ----- ------------------- <br /> BUILDINGPERMIT ISSUED ---- - -- ----- ----------------------------------------------------------------------------------------DATE ------ ------------------- ---------------- <br /> ADDITIONALCOMMENTS ------------------------------------------------------------------------------------------------------------------ ----------------------1-1---------------- <br /> -------------------------------------------------------------------------------- <br /> ---------------------------------------------------=------------------------- ----------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------- ----------------- --------------------------------------------------------------------/------------------ <br /> --------------------------------- --------- ----------- -- -------- <br /> SA <br /> Final Inspection by. - -----------------------------------------------------Date----" ---- <br /> SA JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M, <br />
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