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8197
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4200/4300 - Liquid Waste/Water Well Permits
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8197
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Entry Properties
Last modified
7/25/2019 10:08:28 PM
Creation date
12/5/2017 2:18:27 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
8197
STREET_NAME
FAIRCHILD
SITE_LOCATION
1ST HS E OF ALPINE ON FAIRCHILD
RECEIVED_DATE
11/06/1956
P_LOCATION
BOB GRAY CONSTRUCTION CO
Supplemental fields
FilePath
\MIGRATIONS\F\FAIRCHILD\0\8197.PDF
QuestysFileName
8197
QuestysRecordID
1761670
QuestysRecordType
12
Tags
EHD - Public
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APPLICATION FOR SANITATION PERMIT <br /> Permit No. ------ <br /> (Complete in Duplicate) <br /> Date Issued <br /> A,plica+ion 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 /> 2�,r+ �+k:� --- f <br /> JOB ADDRESS AND LQCATION / p � '. � et <br /> Owner's Name �... ----------------------- Phone------------------------------------ <br /> �77, <br /> Address " =�... = f " <br /> --------------•-------------------------------------------------------- <br /> �� <br /> Contractor's Name----------- ---------- -- ' -------� -------------- Phone.---•------_ ----•---------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -f--- Number of bedrooms $_. Number of baths _ Lot size -- .- -'.--"'--------------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private `Depth to Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: Yes [❑ No P! flew Construction: Yes E-"iso❑ a <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f <br /> Septic Tank: Distance from.nearest welL1ee.-.-:Distance from foundation_-/e----------Material_-_ ------- <br /> No. of compartments-----4---------------- Liquid depth_____-_-..........Capacity...45? ----- <br /> f ' <br /> Cp r <br /> Disposal Field: Distance from nearest weil__/tf_-_-.Distance from foundation.--1Q..----.--.Distance to nearest lot line- ------- <br /> Number of lines-_---_/--__--.-----*_ Len th of each line---- Width of trench.- - �__ <br /> r g , .-- F y. �,0- - ------------- <br /> 11 <br /> Type or filter material _- Depth of filter material----/V...-_`._._._Total length-------/ca�'----------------------`-.- <br /> Seepage Pit: Distance to nearest well----- � _ Distance from foumdation___69.._-_--.Distance to nearest lot <br /> L � Number of pits------1------------Lining material_d_e U-e-4ize: Diameter.-,.�s'-------------Depth.......A'--_------------- <br /> Cesspool: Distance from nearest well_-------r-y------Distance from foundation------------- material--------------------------------------- <br /> El Size: Diameter--- ---- ---- -- ----------.Depth---•----------------------------- -- ---Liquid Capacity_-------------------------gals. <br /> ------------------------------Distance from nearest building.--__-_-__-_-_-___---_-__-_- <br /> Privy: Distance from nearest well.................. ---.-----_.-. <br /> ❑ Distance to nearest lot line-------------------------------------------------- ------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe}:_. % --•-1_G X -----� -- - -- E��'` '�---- -------------- - <br /> --------------------- - -----------------------------------------------------------------•---•--- -----------•------------------------------------------ ------- • ------- ---------•-------------- -- -- <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. <br /> (Signed)-------------------- l` 4� ' G c,,fGf -------- - (Owner-� � . on ractor) <br /> By:----------------------------------------- ---�_...l .�� �l a`------------------------------------------...(Title}..... s�`' , �� ---------- <br /> (Plot plan, showing size of lot, loc�ton of system in relation to wells, buildings, etc., can be placed on reverse si e). <br /> J <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- ---------------------------- -- ---------------------------------------- DATE- <br /> REVIEWED BY------------------------------- - ----------------------------------- ----------------------------------- DATE- c ` - <br /> 5" -- ----- ----------••- -•---- ---•--••-------- <br /> BUILDINGPERMIT ISSUED--------- ---------------•------------------------------------------------------- DATE-----`------------------------------------------------ <br /> Alterationsand/or recommen tions------------------ -------------- -- ----------------------------------------------------------------•-------------------.......------------------------.-.. <br /> -- <br /> --------- ----- ---- ----- <br /> - ( ----------------- --------- -------•--- ---------------------- <br /> --------------------------- <br /> --•----------- -- <br /> ----------------- <br /> -------- - -- <br /> ---------------------------------------------------------- --------------------------------------------------------------------IT----- ------- ------------------------------------------------------------------ <br /> ............---------------------------------------------------------------------------------- --------I----------------------------------------------------------------------------------- <br /> --------------------- <br /> FINAL INSPECTION BY:_--- - C .------..-. Date...--_J_-� J -�_ _ _ <br /> .-------- • •--- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> i. <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C' Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> E5___9 145446 ATwooa <br /> r r1 <br />
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