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4200/4300 - Liquid Waste/Water Well Permits
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9393
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Entry Properties
Last modified
6/16/2020 10:15:35 PM
Creation date
12/4/2017 8:42:32 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
9393
STREET_NUMBER
3621
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
SITE_LOCATION
3621 COUNTRY CLUB BLVD
RECEIVED_DATE
12/11/1957
P_LOCATION
VILLIAGE HOMES
Supplemental fields
FilePath
\MIGRATIONS\C\COUNTRY CLUB\3621\9393.PDF
QuestysFileName
9393
QuestysRecordID
1705634
QuestysRecordType
12
Tags
EHD - Public
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APPLICATION FOR SANITATION PERMIT Permit No. ._, . <br /> (Complete in Duplicate) .1/�1S <br /> w. ,.,..,,..,�. ._ _ _�.. _ . . - Date Issued /------- - •--_ <br /> Application is hereby made to-the SanSJoaquin 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 ANDLOCATION <br /> -------'� I <br /> Owner's Name------------- <br /> -------------------/ <br /> Phone. #- . . <br /> -. 9. <br /> Address. - �T r ---------------------- <br /> Contractor's Name Phone., - l7 <br /> c <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court Motel <br /> € ❑ ❑ .`Other ❑ , <br /> Number of living units: -/----'Number of bedrooms - Number of baths _-Z Lot size _--.___ <br /> Wafer Supply: Public system; 'Community system ❑ Pri ate De th to'Waer Tableff <br /> a <br /> Character of soil fo a-depth of 3 feet:4' Sand ❑ . Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ElAdobeC Hardpan F-1 <br /> Previous Application Made: Yes ❑ No New Construction: Yes No ❑ FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or'cesspool permitted if publ'c rarer is available within 200 feet.) <br /> ��ii <br /> Septic Tank: Distance .from nearest well_, Ao Distance fr$m foundation---f _-----.Materia- .�'/�i _----.___ <br /> y € i/ r <br /> D'rs osal Field; DDtance fromrnearest well pi .- �� Liquid depth----_--------_-_ ---Capacity- *,6 __0 -• <br /> p ---- Size <br /> p stance from foundafion___Q ^pistance to nearest lot line----�0_k. __-- <br /> ----------------------Length of each line---Ze AO__-- v--_-_.Width of french----4_ ----`• <br /> r Type 'of-of lines___-;* t p r �i <br /> Type of filter material---. - QC1 ..Depth of filter material-- .;r� ;__--.- --- <br /> length---------- fes-.-- ----- - <br /> Seepage Pit: Distanceto nearest Il'__ -_w----_-_. -__Distance from foundation '" .. � '.- a <br /> Distance to nearest lot hne'"__--_-- r. <br /> ❑ Number of pits----- '-`--_-�_y'Lining material--- --- --Size: Diameter^{-�--y-- pepth .----- ------ ------ (1 <br /> Cesspool: Distance from nearest w II----_----`... Distance from foundation-------------- <br /> ------Lininmaterial- . <br /> ❑ Size: Diameter---- g <br /> . Depth----------------------------'- Liqu,id Capacity--------------------' ---gals. <br /> Privy. Distance from nearAt"w IIL..-- — - ____.-pislance from nearest building- \ t <br /> ❑ 'Distance'to nearestilot Gne- =�" li --A - <br /> _ <br /> Remodeling and repairing fdescribe - - -_ ' <br /> ----=--' --------- ' ' _ 1 I ' <br /> w <br /> - - -----------= <br /> II ----- --- ---------------- (--------•--------------- ----- -----•---------- ---- -- - - <br /> - ----.--•--- -. r� <br /> - 4 ' -----------• r <br /> I hereby certify that.I nave prepared this application and that fhe work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and r and regulations of the 'Sark.-Joaquin Local Health District.Ar <br /> 4 <br /> (Signed)------------------------- <br /> ----- -----�-�- --- E'..---:(Owner and/or Contractor) <br /> By: - --------- --(Title)--- " <br /> (Plot plan, showing size of lot, location of system in r ation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> Y <br /> _tY'ay M1 <br /> APPLICATION ACCEPTED BY------------!_--- <br /> REVIEWED BY T <br /> = --------------- ------ --- -------•-------------- <br /> -~ A <br /> ----- TE------ �-- <br /> Alterations ons and orING Trecommpendations -.------._._- v <br /> -•----------------------------------------------- ••--- ------------------ ----------------------------------------------•----------------- •---- 1 <br /> -----------------------------------,------------ -------------•---------------------------- <br /> ----•---•-- --------- <br /> 1. <br /> FINAL INSPECTION BY:. = __ ------- Date---- <br /> - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M , :: Revised 1.57 F-P.CO. <br />
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