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21028
EnvironmentalHealth
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BELVEDERE
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4200/4300 - Liquid Waste/Water Well Permits
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21028
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Entry Properties
Last modified
1/3/2019 10:05:35 PM
Creation date
12/5/2017 9:16:09 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
21028
PE
4210
STREET_NUMBER
2952
STREET_NAME
BELVEDERE
SITE_LOCATION
2952 BELVEDERE
RECEIVED_DATE
09/01/1966
P_LOCATION
LAURIE BROWN
Supplemental fields
FilePath
\MIGRATIONS\B\BELVEDERE\2952\21028.PDF
QuestysFileName
21028
QuestysRecordID
1660683
QuestysRecordType
12
Tags
EHD - Public
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FOR OFFICE USE: `. <br /> -a =� <br /> --------------------3:3-_ _-- /tea <br /> APPLICATION •FOR SANITATION PERMIT Permit No. ................ <br /> --------------------- -- (Complete in Duplicate) <br /> 0--- - ----------�.l This Permit Expires 1 Year From Date Issued Date Issued __ `_ <br /> Application 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. <br /> JOB ADDRESS AN LOCATION--- �� ------- �'``'` <br /> ---------------------------------- <br /> JOB ADDRESS <br /> Name-__ . __ Phone- <br /> Address.. <br /> __ �... <br /> . 1Lr? --------- Phone <br /> Address... 1�v�.. .. - . <br /> Contractor's Name---------. _a_ ��D. L�r¢----- - -tit---- - -- _- Phone._/7 _ _ ._ _p` <br /> Installation will serve: Residence ��,r Appaartment Hous�Commercial ❑ Trailer Court ❑ 'Motel ❑ Other ❑ <br /> �l <br /> Number of living units: __ _ Number of bedrooms . -. Number of baths.____ Lot size -____-- __ ._j __--__--_--___.__ <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Tablett lft. <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 x Naw Construction: Yes ❑ No k FHANA: Yes ❑ No X ' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank:r /VGDistance from nearest well----------------- from foundation------------------- Material_________________________________________________ <br /> ❑ No. of compartments-- - - ------ - ---------Size------------------ ------ -----•Liquid depth---------- ----- ---------Capacity------------------- <br /> Disposal Figld:�.ip/Csfance from nearest well--------------- -Distance from foundation--------------------Distance to nearest lot line----------------- <br /> [❑ 0C �� Number of lines-----------------------------------Length of each line----------------------------..Width of french-------------------.._-------------- <br /> Type of filter material-----------------____.__Depth of filter material---_.___.---_________Total length--_-__..________-________________________- <br /> See age Pit: Distance to nearest well.-.141-97-- Distance f om� --- <br /> DIS to nearest lot line_.' -__-_. <br /> Number of pits-----_-----------Lining material__ Q4_------ Diameter---!J'._`.��------Depth_..s��_�'----------------- N <br /> Cesspool: Distance from nearest well_________________Distance from foundation----.---------------Lining material_--____-..__-_._-__--_-____._____.___ <br /> ❑ Size: Diameter------- ------------------------------Depth----------------------------------------------------Liquid Capacity- --------------------------gals. I <br /> Privy: Distance from nearest well ---------------------------_____:_____-.----Distance from nearesf building.---------.--------------------._-.__-.._. 1 <br /> ❑ Distance to nearest lot line------ -----------/---- ---------- ---------- ------------------------- ---------------------- ---------------------------------------------- <br /> 0�2 <br /> Remodeling and or re air ng Idescribe�:-.-___.---- -------- - -- --- --------F--� <br /> � A <br /> Ob <br /> -------------------------------------------------------------•------------•--------------- ------------------------- ------------------------------------------------------------------------- -------------- i <br /> -----------------------------------------------------------------------------------------------•-----------------------------------------------------------------------------------------•-------------------------------- <br /> ----------------------------------------I-----------------------------------------------------------------------••------------------------------------------•-----------------------------•--------------------------------- + <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> Si ned <br /> ( g ) -------------------------------- (Owner and/or Contractor) <br /> ---------/-f- <br /> By:-------' s -- ------ 4'!11 <br /> Vii_. 5't--/r!_ (Title) �"`'�'`''".F/� <br /> (Plot plan, showing size of lot, to " tion of sys relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---------- -- ----------- ------------------- DATE----------- � ----- <br /> ------------------ <br /> REVIEWEDBY----------------------------------- ---------------------------------------------------- DATE-----------------`--•------•---------•---- <br /> BUILDING PERMIT ISSUED------------------- -5 f <br /> -----.-^------- DATE------------------------------------ •--------------------- <br /> Alterations and/or recommendations: � ---- 6-------•-----• --------- ------------------------------------------- <br /> ------------------------ ------------------------ ----------------------------------- -------------------------------------- ------------------------------------------------•-------------------- ------------------------ <br /> --------------•----------------------------------------------------------- --I--------------------- ----- <br /> FINAL INSPECTION BY:_- --------- -- - - �_-.___ <br /> Date / -+ <br /> SA JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California _ Manteca,California Tracy,California <br /> F.P.0 O. <br />
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