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14324
EnvironmentalHealth
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FLORIDA
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4200/4300 - Liquid Waste/Water Well Permits
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14324
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Entry Properties
Last modified
11/19/2018 3:52:09 AM
Creation date
12/5/2017 3:26:54 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
14324
STREET_NUMBER
2920
STREET_NAME
FLORIDA
STREET_TYPE
ST
SITE_LOCATION
2920 FLORIDA ST
RECEIVED_DATE
06/01/1962
P_LOCATION
JOHN HARRISON
Supplemental fields
FilePath
\MIGRATIONS\F\FLORIDA\2920\14324.PDF
QuestysRecordID
1768718
Tags
EHD - Public
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FOR C)FFIC� <br /> APPLICATION FOR SANITATION PERMIT Permit No._04 <br /> ... ._ . <br /> ------------ -- ------ ------- <br /> (Complete in Duplicate) <br /> - Date Issued --- <br />---------------------------------------- _-- This Permit Expires 1 Year From Date Issued <br /> Application is here mode to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is r`' a in compliance with County Ordinance,No. 549. <br /> .Ir -------------------_ _ - <br /> Owner's Name..... .................. --•--•----- .................................. Phone..................................... <br /> 1 p <br /> Address s .��.4 .--- --- -. -------•------ <br /> Contractor's Name--------------- --...... . . _- --------------- Phone------_'.:. <br /> installation will serve: Residence ❑ Apartment House [Commercial_❑y Trailer,.CourF ❑ Motpl ❑ Other <br /> Number of living units: ,__ Number of bedrooms ---Y Number of baths _ Lot size . _. ___ z?:.......................:.. <br /> x? 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: (if yes,date____________________) No New Construction: Yes R3"'No ❑ FHA/VA: Yes ❑ No E_ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: Al <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest wesl "__=_____Distance from_fopundatiion____�Q___'_,_Materia,___� �. <br /> No. of compartments____c.i�--____,c_____--_Size�......_ei� 1 Li uid depth-_ _____Ca aci �M. V...... <br /> q P. = P tY .... <br /> Disposal Field: Distance from nearest well__ ---------...-.Distance from foundation___ _____:_,Distance to.nearest lot line.�...J..... r f" <br /> Number of lines........ ___ Or <br /> Length of each line____ _ Width of trench___ ____________________________ _ <br /> Type of filter meterial,f � Depth of filter material___, ��'--. Total length.__/ ---_.__________---___.. <br /> � r <br /> Seepage Pit: Distance to nearest well____-._ ' .-----Distance om f undatian___. .......D s rete #o nearest lot line__ _____ l <br /> Number of pits------- Lining material __.Size: Diameter--S,.? p y <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__'::I._._..___.__________._....-. - <br /> [❑ Size: Diameter--•-----------------------------------Depth----------------------------------------------------Liquid Capacity-"-------------------------gals. � 1. <br /> Privy: Distance from nearest well_------------------------------------------------Distance from-nearest building_______:-_-.------_-----___.__._______- <br /> ❑ Distance to nearest lot lin.e-----------•-••----------•------------------- - -•-------••------....... <br /> Remodeling and/or repairing (describe)=---------------_ -------•--=--•-------•-•--•---••-------- <br /> ------------------------ •---••------• ---------------------------------------------`-----._......-•----------- - <br /> ---------- -- ------------------- -----------------------------------------------•-•------------------------------------ --- ------ <br /> I - <br /> •---------------------------------------------------------------------------------------------------------------•------------------------------------------------------------------------- •------------•------------------- <br /> I hereby certify that I have prepared +his application and that the work will be done in accordance with San:Joaquin County <br /> ordinances, State laws, and rules d regulations of the San Joaquin Local Health District. '' <br /> (Signed)----------------------------- - --- -------- - - ------------------------ -- ------------------------------------ or Contractor) <br /> BY: -- ------------------ <br /> of system in rel o wells, buildings, etc., can be placed on reverse side). <br /> • 1 <br /> R D"RTMENJ USE ONLY <br /> APPLICATION ACCEPTED BY-- ------ -- DATE---------- Z�------------------ <br /> REVIEWED BY------------------------- <br /> ---•-•- ------------------ --------------------------------------------'--------------- DATE------------------------------------------------------------ <br /> BUILDING PERMIT ISSUED-- -• ---•------------------------------------ - - DATE -------------- <br /> Alterations and/or recommendations:-__ ---.__-- -.- - _ -- .�- .._._.�of�.-�. -��} t ................... i <br /> -------------------•- -----------------------------•---•-------------------- -•---------------------------------------------------------------------------------------------------------------------------. --•----------... <br /> FINAL INSPECTION BY-4 -- R ----------------------- \\Date------(-------`------------------------------------------- ------------------------------------ <br /> .SAN J_OAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American.Sfru! �+ X300 Weil Oak Street 5 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,--California Manteca,California Tracy,Californla <br /> E9 9 REVISED 8-59 ZM 5-61 ATLAS <br />
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