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71-690
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4200/4300 - Liquid Waste/Water Well Permits
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71-690
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Entry Properties
Last modified
2/26/2019 10:59:27 PM
Creation date
12/1/2017 4:22:31 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
71-690
STREET_NUMBER
414
Direction
N
STREET_NAME
ORD
City
STOCKTON
SITE_LOCATION
414 N ORD
RECEIVED_DATE
07/27/1971
P_LOCATION
F BRIDEWELL
Supplemental fields
FilePath
\MIGRATIONS\O\ORO\414\71-690.PDF
QuestysFileName
71-690
QuestysRecordID
1886637
QuestysRecordType
12
Tags
EHD - Public
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FOR OFFICE USE: • •� � <br /> w - APPLICATION FOVSA - DATION PERMIT <br /> ------ -- -------- ------------------ \ * e l <br /> Permit No: - <br /> -- - - <br /> a�- (Complete in Triplicate) <br /> ----------------------------------------------- <br /> l This Perm!t.Ex ires 1 Year From Date Issued Date Issued _7:Z-_7 �l <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> i described. This application is made in compliance with Cop,. ty Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION _ , { '. rJ ��'=----------------- ----------------------- --- -CENSUS TRACT -------------------------- <br /> /� ' -----------------Phone <br /> Owner's Name ---- - % e--- <br /> �. --- �-� _ -------- - <br /> Address --- /77 �� - � _ __sY ---- - <br /> Contractor's Name --- __-- --_-_7 -- ------`r -_.License # - -- P/ 2- Phone <br /> Installation will peke: Residence Apartment House❑ Commercial ❑Trailer Court ;❑ <br /> .. Motel ❑Other ------------------------------`------------- <br /> Number <br /> ---- ----Number of living units:-_-/ ----- Number of bedrooms _91_____Garbage `Grinder l4-0--- Lot Siziep'- -- - --------------- <br /> Water Supply: Public System and name _ } "- 'iy _________________ ___Private ❑ <br /> 111 - /�! �-l�r_ 't" -- - -i <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sand !loam Clay Loam ❑ <br /> Hardpan ❑ Adobe% Fill Material -------------If yes, type --------------------------- <br /> (Plot <br /> -------------- --_--(Plot plan, showing `size of lot, location of system in relation to wells, buildings, etc. must' be placed on reverse side.} <br /> i NEW INSTALLATION: (No septic tank pr seepage pit permitted if public sewer�sriavailable within 200 feet,} <br /> PACKAGE TREATMENT [ I SEPTIC TANK Size_/ �--^ <br /> /k tT " �iquid Depth <br /> Capacityr0 �/,___ Typef� -- Mateal � s'-- No. ,Compartments --------_------------ <br /> r! <br /> ` Distance to nearest:'Well -----_____ ----_ <br /> . '; ''-' ---- -:---- ---foundation "+/f�-�-------- Prop. tine ---��-�----`-- <br /> t � � g ` f <br /> I LEACHING LINE (�� No. of l.,ines ___fi�-___----_______ Length o�ach line___ � __ ______�-,----__-_-- Total Length �_ ;,�---____n_-•. <br /> 'D' ox` __4 Type Filter Material epth Filfer tMaterial ---------________________ _•_ <br /> f ••- <br /> Distdnc ;1:o nearest: Wel! ----. --.____------ Founda io ��;Property Line ---�.------•---.-•--- <br /> SEEPAGE PIT �Q Depths �n ``___ Diameter -i,"____ Number ` __._. _ _____:Rock Filled Yes ' No I❑ <br /> �I � --------- - Rock Size <br /> {DWcte .6pth <br /> Distanceto nearest: Well ------------ ---------------__Foundation .......... Prop. <br /> __-_ ProP• Line _____i__ <br /> ___ <br /> REPAIR/ADDITION . <br /> (Prev. Sanitation Permit# -------------------- Date -______________ `-----_--- } <br /> _ <br /> Septic Tank {Specify Requirements) -- ---- 'i ��'- ` <br /> Disposal Field (Specify Requirements) ----------- P--------------I------- ---------------------------------- , 1�`---------------------------- --------------- <br /> ------------------------i <br /> ---------------------------_ :•------- <br /> -------------------- <br /> --------------------- - - ---- ------------------------- -------------------- ------ - -------------------------- <br /> red addition on reverse side) �--, `� <br /> (Draw existing and required - , <br /> I hereby certify that I have prepared this application and 'that the work will be done in accordancewith-San Joaquin <br /> County Ordinances, State Laws, and Rules'cnd, Regulations of-the San Joaquin Local Health District. Homeowner or licen- <br /> sed agents signature certifies the following: <br /> `> f <br /> k. "I certify that in the performance of the work forswhich this permit is issued, I shall not employ any person in; manner <br /> as to become subject to Workman's Compensation Jaws of California." <br /> Signed ------------------ - -- - ---------- ----------- Owner l <br /> --------- <br /> BY s-=_ _._-..__7.i£le <br /> --------- 't s��1" -------------------------- <br /> (If of than owner) - " <br /> - <br /> { FOR .DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -------- f�__/1 ---- -- c�----------------f----------- DATE -- --=-- - --- - �---- <br /> BUILDING PERMIT ISSUED ------- ---------------- -------DATE -------------•----------------------------- <br /> ADDITIONALCOMMENTS -------- ---------------- --"------------- ------------------------------------------------------------ <br /> R ________________ _____________________ - J-_________-________ _ ___--- /--------------------,----------------------:--____________ __ ------------ <br /> ----------------- <br /> -- ---------- <br /> -_"________-----_ <br /> -------------------------------- - ------- 7 ----- . -:�. 1 <br /> ---- ----- - ----------------- <br /> i --- ------------ ---------- -- \ <br /> Final Inspection by: ---- ------� --- ----- --------------------- Date 4 �"- <br /> - -- - - - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT',/ <br /> E. H. 9 1-'68 Rev. 5Mr�- <br />
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