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18914
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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18914
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Entry Properties
Last modified
12/23/2018 10:05:25 PM
Creation date
12/5/2017 3:42:16 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
18914
STREET_NUMBER
11665
Direction
E
STREET_NAME
FOSTER
STREET_TYPE
RD
City
ACAMPO
APN
01725005
SITE_LOCATION
11665 E FOSTER RD
RECEIVED_DATE
05/04/1965
P_LOCATION
PRINTAM SINGH
Supplemental fields
FilePath
\MIGRATIONS\F\FOSTER\11665\18914.PDF
QuestysFileName
18914
QuestysRecordID
1770564
QuestysRecordType
12
Tags
EHD - Public
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FOR OFFICE USE: <br /> ----- -------------------------------------- �^q <br /> -------------------------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. .......... <br /> f;.... <br /> ----------------------- (Complete in Duplicate)------------------------- Date Issued <br />_---------------------.-------------------------------- --- This Permit Expires 1 Year from Date Issued 17_ zsv—OS <br /> Application is hereby made to the San Joaquin Local Health District for aipermit to construct and install the work herein ed. <br />'- This application is made to comp-ance.,with County Ordinance No. 549. <br /> QJOB ADDRESS =19. AII_ I '' 1, ------------ -- ---�----- ?f�U <br /> Owner's Nam __ <br /> - - --- ------- -------- ---- ---------- - ---- Pone.._...---•-•---------- <br /> Address_._ l....._ ------------------•-•-----••----•------------ <br /> Contractor's Name--.-- ----- •• - ---- -... ` ' --------------------------------------------- -•-------- Phone---•-----.---------•---- - <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _/____ Number of bedrooms -5- Number of baths __/_-_ Lot size ____ <br /> --------- <br /> _------ <br /> _ <br /> Water Supply: Public system ❑ Community system ❑ Private WDepfh to Water Table ________ ft. <br /> Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam Clay Adobe Hardpan <br /> . P ❑ ❑ Y � Y ❑ Y ❑ ❑ ' ❑ <br /> Previous Application Made: ilf yes,dote--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ -No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: - '1 <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet,) <br /> Septic Tank: Distance from nearest well------------------Distance from foundation-------------------_Material-----------------------------.__-----__-..._____- <br /> ❑ No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity--••-------••---------- <br /> Disposal,Field: Distance from nearest well__�a.l__Distance from foundation____/•�_-----__.Distance to nearest lot line.__-�.____-�• <br /> Number of lines__----------r!_____'_-_.- __ Length of each line___�P_'_____________Width of trench.___Z__--________________.____ ., <br /> Type r p ,�` _ _..Distance to nearest lot line_S__--_____- <br /> T e of filter maaerial____ ___ ______________De th of.filter material_-_-/91_-_-_-___.___Total length---S C�______-__ <br /> • __.____Distance from fo ndation____ <br /> Seepa Pit: Distance to nearest well_____._.-- -_.pe th_.��-_-________________^ �.- <br /> �-+ <br /> Number of pits_ ..:_----------Lining material--------V-�-.Size: Diameter-------� ------_ p � <br /> t' l <br /> Cesspool: Drstance from nearest well_________________Distance from foundation material--.. _-___-__. ' <br /> ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gad <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----------------------------------------.� <br /> ❑ ,_ Distance`to"nearest lot line--- ,- ...� .-- _ .— --- --------------- ------ <br /> Remodeling and/or repairing {describe :---- --eze_ <br /> ----------- --------------------------•-••-•-------------------- ----•----------------------------_-•--•---•------------- <br /> N <br /> -------------------------------------------------------------•------------ - <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 gdnrules and,regul ions of the San Joaquin Local Health District. <br /> (Signed)------------------ ----------- ----- - - - <br /> (Owner and/or Contractor) <br /> (Plot plan. showing size of lot, location of system in relation wells, buildings, etc., can be placed on reverse side. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_ ' !��Y!/ -__-__ DATE--r �_- <br /> -- -------------------------------------------- <br /> --------------------------- <br /> REVIEWED BY---------------•--------------------------------------------------- DATE------------------------- <br /> -.---------- - -------- -----------------------------•- <br /> ---------------------------- <br /> BUILDING PERMIT ISSUED--- ---- DATE-------------------------------------------------------------- <br /> Alterations and/or recommendations:-------------------------------------------------------------------------------------------------------------------------------•---•--------------------------- <br /> ------------------------------------------------- ---------------------------- --------------------------------------------------------------------------------------------------------------------------------•------- <br /> --------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ----------------- ---------------------------- - ------- -------------- ------ --------------------------•-•-------•-------------------------- ---------•------------ ----------------------------------------------------- <br /> FINAL INSPECTION BY:.. ---------- <br /> Date------ -- --��r�------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stocklon,California Lodi,California Manteca,California Trac>,California <br /> 96 9 REVISED 8-59 3M 3-'63 F.P.CD. <br /> 1 <br />
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