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12887
EnvironmentalHealth
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BACON ISLAND
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4200/4300 - Liquid Waste/Water Well Permits
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12887
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Entry Properties
Last modified
11/1/2018 7:23:37 AM
Creation date
12/5/2017 8:23:00 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
12887
STREET_NAME
BACON ISLAND
STREET_TYPE
RD
SITE_LOCATION
BACON ISLAND RD ON WOODWARD ISLAND
RECEIVED_DATE
03/08/1961
P_LOCATION
S MORRIS CRUDELI
Supplemental fields
FilePath
\MIGRATIONS\B\BACON ISLAND\0\12887.PDF
QuestysFileName
12887
QuestysRecordID
1655876
QuestysRecordType
12
Tags
EHD - Public
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FOR OFFICE USE: <br /> --------------------------------------------------------- APPLICION FOR SANITATION PERMIT Permit No. ___12__ <br /> --------------------- --------------- ------------------- W <br /> (Complete in Duplicate) 3//., <br /> ------------ ------ f Date Issued --- /�....... <br /> fj,=-_z D.4-0- <br /> ---- —----------------- This Permit Expires I Year From Date Issued <br /> I c 'in <br /> AppliCation is hereby made to the San Joaquin Local Health District for a perrn.it.,,to construct and ffaf I ework hij4ie';n.dbscribed. <br /> This application is made in compliance with County Orclinan%o.;54_9-;ka - 77 <br /> I r3 .. <br /> JOB ADDRESS AND LOCATION... ------A------ . ......................1 11 <br /> --------------------- <br /> ----- <br /> ------ -----------• ------- -------------- 457 <br /> Owner's ------ 1jL ------- P:,hone--# 3 <br /> -------------- ---------------------- ---------------------------- <br /> i, 'w, <br /> Ac1dress_....1.-�C14_ ---- <br /> -------------------- --------------------- Phone..... :.�.__:__:_.. I <br /> Name-_46tan.716e1_11� ------_-=- <br /> Motel 0 Other 0(,oejA&--L <br /> Installation will serve: Residence 0 Apartment House [3 Cor�ti�erc`igl*❑' T�-""a 4 1 'b <br /> Court <br /> P <br /> Number of living units: -------- Numof bedrooms J---- Numb # ------------- ---------------- <br /> 16 <br /> g,rv�4.rcD <br /> Community system El Privif4,t9-,Qepfh4o Water.'-Tbbli, <br /> Wafer Supply: Public system [I PFA-r <br /> Character of soil to a depth of 3 feet: Sand E] Gravel [] Sandy loam;.% .Play,Loam- Clay 0 'Adobe[:] Har pan [:] <br /> Previous Application Made: (If yes,date--- ________________l No 10 New, strucfgn%A,,�� <br /> __kCon s-0 Nb'E1 '* FSI A/VA-'Yis [].. No <br /> TYPE OF INSTALLATION AND SPECI FICATIONS- <br /> 1* <br /> (No septic tank or cesspool permitted if public sewer is available within !QQ feet.) <br /> )6, <br /> Septic Tank: Distance from nearest well_s,_0�4__Distance from foundation_--5--------------Maferial-PAA—C-5- -�---- ---------- <br /> ---------------Size__3 <br /> No' of compartments------- 1K.?_Sc_5�--------Liquid clepjh__ <br /> ---------------Capacity ,490,0�_ <br /> Disposal Field: nearest well,_676.` Distance from foundation___ ------- ____Distance nearest lot line_________________ <br /> Distance from ni� __+_ `- <br /> Num" ber of lines-------�Z--- ------------------Length-of each line---�7--5--," 1 _1�6 ------- ------------ <br /> ------ -----�.Vidf trench <br /> Type of filter maferiaI.._,k7L5.C_A-" -Dopfh,o ----Total k lengf h----/_!57�......................_ Zll <br /> Seepage Pit: Distance to nea-rest well----------------------Distance from foundation_----------LDistance to nearest lot line-------------- ZHI <br /> N! -------- --------------10 <br /> El umber of pits------------------ Lining material-----------------------Size Diamefe'r Depth------------------- <br /> %Cesspool: Distance from ne6resf,wVll_�- __jL%_—DisfbPrEe'from foundation------------------_...Uni�g material______-___________-_._,..__.._...__., <br /> 11�1 - - <br /> --------------- Depth_ ../------------ -------- <br /> 0 size: Diameter':-=_- --------- -_Liquid <br /> apacify---------------------------gals <br /> Distance from neng---. <br /> X <br /> 6fPrivy- Distance from nearest we estrb�j Cld i ----------- ----------------------- <br /> ------------------ <br /> ----------- <br /> pstjof line--------- ............ --------- --------------------------- -------------------------------------- ---------------- <br /> lit, <br /> Remo tiling and/or repairin�61fdgsctibe), <br /> - ------------------- <br /> ------------------------------------------------------------ ----------------------------- <br /> ------------------------ ------- ----------------------- ---------------------------- --------------- --------------- -------------=-------------------------------------------- ---------------- <br /> -v4^0— il 0 � 4"i,-,_- - I huft-6j'..N <br /> ------------ ........----------=------------------------ ------------------------ -------------------------- ---------------------------------- ----------------------------- <br /> -4 e r � ` es'�aPF ift a w <br /> '�j hereby certify thatYXave pri�paced Aii--" lic icAnd that the work" illbe done in accordance with San Joaquin County <br /> ordinances, State law an I 'Rule's and regulations of fA San Joaquin Local Hlialfh District. <br /> (Signed - -- ------ ----- -- -------------- ------------------------------- ----------!-------------------------------(Owner and/or Contractor)�j <br /> i <br /> By:_-------------------I ----- <br /> f � � <br /> -- --- --- --- ------------------------------------------T�.(Tifle)---------------------------------------- - --------------- <br /> (Plot plan, showing sizeof I't,d6cafion of system in relatior I Fto wells, buildings, etc..can be placed on reverse side). <br /> FOR DEPARTK4ENT.,,USE ONLY 17 <br /> APPLICATION-ACCEPTED -----------I--------- DATE--Z-------5-------- -------------------------- <br /> - ------ -------- ------------------ ------ --------- <br /> REVIEWED BY--------------------------------------- ......... .......... DATE------------------------------------------------------------ <br /> ..... . ............. <br /> ------------------ <br /> BUILDINGPERMIT ISSUED--------------------L--------------------------------------- ------------- --------- DATE------------------------------------------------------------ <br /> Alterations and/or recommendations--------_=--------------------------------=------ -------------------------------------------------------------------------------------------------------- <br /> -- <br /> ----------------------------------------------------------------------------------------------------------------------I----------- ---------------------------------------------- -------------------------------------- <br /> --------------------- -------- <br /> ----------------------------------- -- ------------------ -------------------------- ----------------- ------------------------------------------- ------- ........ ----------------- <br /> ------------------------------- ------ ---------------------------------------------- -------------------------------------------- ------------------------------------------------------------------------------------------- <br /> -------------- --------------------- ------------ ----------------------------------- ------------------------------------------------------------------------------------------------------------------------------------- <br /> --- - -- <br /> FINAL INSPECTION' BY:— ----- Date----__?------- - ---------•---------•-•----------------------------•--••-•- <br /> - -—----6�11----------------------- ----------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 730 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stocktonr California Lodi,California Manteca,California Tracy,California <br /> CS-3 REVISED a-59 F.P.CUL 2M 6.60 <br /> ALI-, <br />
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