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77-762
EnvironmentalHealth
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11493
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4200/4300 - Liquid Waste/Water Well Permits
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77-762
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Entry Properties
Last modified
5/30/2019 10:09:39 PM
Creation date
12/4/2017 9:22:22 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
77-762
STREET_NUMBER
11493
Direction
N
STREET_NAME
DAVIS
STREET_TYPE
RD
City
STOCKTON
SITE_LOCATION
11493 N DAVIS RD
RECEIVED_DATE
09/16/1977
P_LOCATION
TONY MARTIN
Supplemental fields
FilePath
\MIGRATIONS\D\DAVIS\11493\77-762.PDF
QuestysFileName
77-762
QuestysRecordID
1711502
QuestysRecordType
12
Tags
EHD - Public
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FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ----------------- ------ -------------------------------- <br /> Permit No.._77—_7C Z <br /> ( (Complete in Triplicate) <br /> --------------------------------------------------- --- - k <br /> Date Issued._fF_=_Zq`- <br /> -----------------------------------_______________________ This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION--- _�-T_1__, __._------------- <br /> � li( t <br /> ---------- ----------- -� ------ ------ ----`----------.CENSUS TRACT- <br /> - <br /> RACT <br /> Owner's Name. ---- -----`--- - ----------------------- --------------------Phone------ .--- ----------------------- <br /> _ <br /> Address--- - ---------- �` ;1� 1 -4- af- <br /> Installation <br /> -- city -------- --- Zip <br /> CE'l <br /> Contractor's :Name- --- �/«` �� . <br /> License #- '__ Phone-______________ <br /> - -f�-�z� - ------ •------------ <br /> r will serve: Residence ❑ Apartment House.E] Commer�ial ❑ Trailer Court ❑ ; <br /> Motel ❑ Other ;. <br /> Number of living units______ ____-------Number of.bedrooms _.��____Garbage Grinder_,.----------Lot'Size.--."_���-�-�����___. <br /> Water Supply: Public System and name = ------------------ <br /> ----7------m -------------.. -.-_::- -.-.:.-------------- --------------------------------Private [ 4 <br /> Charact of soil to a depth of 3 feet-- Sand ❑ Silt❑ Clay eat ❑ Sandy Loam ❑ Clay Loam ❑ <br /> - .._.,. ,. _. ye'_r p <br /> Hardpan ❑)Adobe'❑ 'µFill Material._._ ____"If ty e-_______________'---- ------. <br /> (Plot plan, showing size of lot, locationcof system in relation to'wells, buildings, etc, must be placed on reverse sid .) <br /> NEW INSTALLATION: (No-'septic,'tank .or see age pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE,TREATMENT [ ] SEPTIC-TKNK 'I; Size �/L,� _li ._l <br /> �•s I r <br /> -----------------Liquid Depth --- --- ----------- - <br /> .T ; Capacity--t_F s _:Qa -.`TYpi Matarial-_: - -------- -_.F-No. Compartments-----�---------__------- <br /> ;. f - <br /> LEACHING LINE [ ] Na. of Lines dearest: Well ----------- _ Foundation._:___L_Q_ _____ Prop. Line---- <br /> --------------- __._.. . <br /> _ /Distance to n <br /> ��Length of each line Ti -'` Total Length-------- <br /> -�--': D' Box----I-°-----Type Filter'-Material-----J-- -----Depth Filter Material---'----1-=1----------------------------------------------I "i <br /> I Distanca to nearesf: Well l_.d �. FoundationProperty Line---------- <br /> SEEPAGE PIT [ Depth__�__�_ iameter.. - ___-Number____.____v _______ »�. �, Rik Filhed `'Yes No <br /> != Water Table Depth �v = Rock_ Sizel� 'tax r �1--- ------ ----- <br /> Distance to nearest: WeEI _— —� W <br /> _ r __-___-Foundation.__------_�/K?::_ rop. Line_______ . <br /> -. :Date _.�.--: :__ <br /> REPAIR/ADDITION (Prev. Sanitation Permit#________ ________------------- <br /> - ------j F <br /> Septic Tank (Specify Requirementsir------------------------------------ ----.------------------------------------ ,. -_= 1 = ------=------------------------------------------------------ <br /> Disposal <br /> -----=-- ------------------------------Disposal Field (Specify Requirements)------------- •;------------.------------ ` - = - <br /> k <br /> -------------- -------------------------- --- ----- <br /> ----- --------------------------------------------------- ----------------------------------------------------- ----------------=------------------------------------------------------- -- ------- ---------- <br /> 3 (Draw existing and required addition'on" reverse side)' �•� <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_ Laws, .and Rules and Regulations of the. San Joaquin Local Health District, Home owner or licensed agents <br /> signature certifies the following: i <br /> "I certify that in the performance of the work for which this permit is issued, 1-shall no+employ any person in such manners <br /> to become subject to.Workman' .Compensation laws.of California.",. ; <br /> a [ <br /> Signed------ Owner <br /> Title - <br /> BY ''�r�t� - ------------------------ <br /> (if <br /> ------- -----------(If other than owner) <br /> } FOR'DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED, BY______ ___________- -- -�_--------- <br /> = DATE - l�A ' -�---------------------- <br /> DIVISION OF LAND NUMBER-------=- ----=--------- ------ ------- .DATE-=---- ----- <br /> ------ ------- <br /> ADDITIONAL COMMENTS-------------------------=.._----_------ <br /> i ` <br /> .. ' ---------------.--- --.-----_------._---- ----------------- --------- --------------".-. <br /> -"_-"----------------------------------------- i <br /> Final Inspection by:- i----- `-_ ---._:w.=__:.--- - -------------------------------------------------------- ---Date --.�---- --- -� -�----------------. <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV,7/76 3M <br />
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