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74-175
EnvironmentalHealth
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FAIRMONT
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4200/4300 - Liquid Waste/Water Well Permits
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74-175
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Entry Properties
Last modified
4/9/2019 10:06:39 PM
Creation date
12/5/2017 2:27:43 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
74-175
STREET_NUMBER
2845
Direction
S
STREET_NAME
FAIRMONT
City
STOCKTON
SITE_LOCATION
2845 S FAIRMONT
RECEIVED_DATE
03/14/1974
P_LOCATION
VINCENTE CACHU
Supplemental fields
FilePath
\MIGRATIONS\F\FAIRMONT\2845\74-175.PDF
QuestysFileName
74-175
QuestysRecordID
1762289
QuestysRecordType
12
Tags
EHD - Public
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.J4 <br /> FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT ''// <br /> .....:. .............................._....._.... Permit No. 7Y. .......... <br /> (Complete in l Triplicate) ! <br /> ... This Permit Expires_1. Year From Date Issued Date Issued .............. .... <br /> Application is hereby mode 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. 544 and existing Rules and Regulations: <br /> I r� <br /> JOB ADDRESS/LOCATION .._...... .T_ -....-5-..__ CENSUS TRACT .......................... <br /> ...... -----•-----`---_....... ........... .. u�....l`. J' � <br /> Owner's Name ...._......V../.N.I.����................ -----.............Phone 1..._. 7`"�.,� ...-..�--�,..., <br /> Address .. - - J' '., __.... ... 1'. .. N�..........•... City <br /> ... � 't/ <br /> Contractor's Nome ..........S L. . 7.... ..............-------..._._.:------------------- --.License # . _/�`. ---. Phone ........................... <br /> Installation will serve. Residence"Apartment House❑ Commercial ❑Trailer Court :❑ <br /> I <br /> Motel ❑ Other .... .r/L-6i----•---- <br /> Number of living units:..;..../. Number of bedrooms ;2------ Grinder ............ Lot Size ._.f. .. ............... <br /> Water Supply: Public System and name ............................................................ ------------------ --------------- ..............Private ❑ I <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe Fill Material ............ 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 /> NEW INSTALLATION: JNo septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK j£� Size._. ..._ _ � .. Liquid Depth ....... .................. <br /> Capacity I—!, .... Type .............. Material Material---------------------- No. Compartments ................... <br /> Distance.to ne st:a,Well. ,_,.r .: Foundati n ............._.------ Prop. Line ...................... <br /> LEACHING-LINE [ ] No. of Lines / � hof eac`l1 sire .. . H� Total Length .. ---- 'gip <br /> 'D' Box __.. T <br /> ype Filter Material�:_:��.._.__Dept Filter Materia) _... c,7.../f.:r.�___....... <br /> Distan a to ear4st: WAIII .._ u.----..-_.1_ Foundation .I�. .. Property Line <br /> SEEPAGE PIT [ ] DeptpxXX.��-F-Diameted .............. Number 0.4.... ............. Rock Filled YesX No ❑ <br /> Water Table Depth .... •..---•.......................Rock Size .............. <br /> Distance to nearest: Well ........................................Foundation ...... ............. Prop. Line ...................... <br /> REPAIR/ADDITION lPrev. Sonitotion-Permit# ------------------------------------------ Date,----------._..-------.-----------.1 <br /> Septic Tank ]Specify Requirements)-, a..` -- ----------- --------•-----.._---L .---•----•--------------- <br /> ' �� bbb <br /> Disposal Field {Specify Requiremerlts �..__-_�7 . �.--- ....� ....._...�� �� <br /> �coo�[J 4► <br /> .... .�.-_.. <br /> .............. . : . Q. � .. - -------- ----- ----------------------------- ------------. ....-._ <br /> (Drdw exist' g and required additio on reverse side) <br /> 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 /> as to becom s;other <br /> Ethan <br /> an's Compensation laws of California." <br /> r <br /> Signed - ----- --------------- Owner <br /> 8 .. ... .._. .... . ----- • ................ Title <br /> (Iner) <br /> R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ..... .. - .. .... . -------- DATE4..�•••-••.••••••. <br /> BUILDING PERMIT ISSUED - .- ---.DATE _...- ....... <br /> ADDITIONAL COMMENTS ... <br /> -- <br /> -- <br /> .......... <br /> ---------------_..._......... .__ .._�_....-. _._.D. _..... ....... ._ -...._....._-____._._... ........ ..1.._ _.___...............-........... E <br /> ......................................... .. ....._ --_.._.... ..,..._..... ..--------- ----.-- .....__...-..._..___._.._._._ ._..-_..--. _... <br /> FinalInspection by. ... ..............................• -------•- -----.._..------------------------------ ---.._...:---......_Date ..... ... .. `.1... E <br /> SAN JO UIN LOCAL HEALTH DISTRICT <br /> F H 13 241-'AA 12P.. $;AA x7172 3.14 :?_ <br />
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