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5019
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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5019
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Entry Properties
Last modified
1/25/2019 11:24:17 PM
Creation date
12/5/2017 8:57:05 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
5019
STREET_NUMBER
815
STREET_NAME
BEATRICE
STREET_TYPE
ST
City
STOCKTON
SITE_LOCATION
815 BEATRICE ST
RECEIVED_DATE
3/23/1954
P_LOCATION
LUTHER SPEEGLE
Supplemental fields
FilePath
\MIGRATIONS\B\BEATRICE\815\5019.PDF
QuestysFileName
5019
QuestysRecordID
1658831
QuestysRecordType
12
Tags
EHD - Public
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.MIo APPLICATION FOR. SANITATION PERMIT Permit No. 01.7...... <br /> (Complete in Duplicate) Date Issued <br /> Applica+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. s <br /> � --------------------------••-- f <br /> JOB ADDRESS AND C TLO ---------"-iJ> � - '�' ' � <br /> ----- <br /> Phone__ ._ ------- <br /> T_ <br /> -._. _'_- � <br /> Owners Nam - •---- •-�`/_-- - -�-�`-�-------- --- •-�'�—�f----- -------- ------------------------------------------------ . <br /> Address. ------ --- --------- ---- - --------------------------------------------------- ---------------- ----------------- <br /> Contractor's Name_----- -- --• ...... rte j--- ------ _•------------------------------------ ------- Phone - <br /> _ _ <br /> Installation will serve: Residence Apartment ouse ❑ Commercial ❑ Trailer,Court ❑ Motel Other ❑ <br /> ; Number of living units: _/--- Number of bedrooms Number of baths _/__ tot size -- - ----------- <br /> Water Supply: Public,systemCommunity system ElPrivate L] Depth to Water Tab[e, — <br /> Character of soil to�a depth of 3 feet: - Sand F] Gravel E] Sandy Loam [I Clay'Loam ElClay ❑ Adob� Hardpan ❑ <br /> Previous Application Made: Yes ❑ No New Construction: Yes ' No ❑ E �I <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: I <br /> (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) j <br /> Septic Tan Distance from nearest we!!________________Distance from foundation____________________Material----------------------------------------_______-. <br /> No. of compartments-------------------------Size------- -------------------,_°.Liquid depth-------------- ---------Capacity----------------------- <br /> Disposal .iel Distance from nearest well---___.________Distance from foundation_______-____._.----Distance to nearest lot line_________________ <br /> Number of lines-----------------------------------Length of each line-------------------------------Width of french-------------.----------------------- <br /> Type <br /> .______--___--------- V� <br /> Type of filter material-_____________________Depth of filter material----------------------- length---------------------------------- <br /> Seep <br /> ________-_-________--- __________ : <br /> 5eepa e Pit' Distance to nearest well --_Distance m fo dation_' -,_____.Distance to nearest lot li T__a�___.. <br /> Number of pits------�------------Lining material-----ll----Size: Diameter_- .r______------Depth-------. --------------- <br /> . , <br /> Cesspoal; Distance from nearest well__________'_____Distance from foundation-- ________- -__ Lining material_`_________________________-_--______- <br /> ❑ Size: Diameter-------------------------------------Depth-------------------------- ------------------------Liquid Capacity -----------------------gals. <br /> Privy: <br /> Distance from nearest well______________________________________________._Distance from nearest building_:_______.._.__________--_-__.=-� ' <br /> ❑ Distance to nearest lot line:---- -------- ------- ----=----------•- ------ -------------------------------- <br /> �11�_? A <� :r ---- •-----—--' ------------------ <br /> Remodeling <br /> and/orirepairing [describe}:_...� _ _____ _.y� <br /> - -)------ --- �-----------, <br /> ----- ----------------- - <br /> •fes__... _ <br /> /aree4 <br /> ------•------------------------------------- <br /> ----•---------------------------------------••----------•--------I hereby certify that l have prehis application and that the work will be done in accordance with San�Joaquin County <br /> ordinances, State-laws, and ules and regulatio of the San Joaquin,Local Health District. <br /> /,/5 _ __-___n_------Owner and/or Contractor <br /> ( itle l i <br /> By:..................••'-=- ...--- <br /> �--- -------------------------------------------------- T = <br /> (Plot plan, showing size o�-lot, location o system in relation to wells, buildings, etc., can be pla don reverse skde}. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY �1Zh I- - ------------------------ DATE-------�J �' S --------------------------- <br /> REVIEWEDBY----------•------------------ ------------------------------------ --- DATE = = <br /> BUILDINGPERMIT ISSUED----------------------- -- ------------- --•--- DATE--------------------------------------• -------•----------- <br /> Alterations and/or recommendations----------------------------- ------------------- --------------------: -------------------------------------------- <br /> x .. <br /> --------------- <br /> -------•------------------•-------------------------------•-------- <br /> ------------ -----=----- <br /> # FINAL INSPECTION BY:----------- = � ------ Date--------- - 'Z - - ------------------------------------------------ <br /> SAN <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9—•2M Revised W-2100 <br />
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