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68-1035
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4200/4300 - Liquid Waste/Water Well Permits
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68-1035
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Entry Properties
Last modified
2/5/2019 10:40:10 PM
Creation date
6/28/2018 9:39:23 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
68-1035
STREET_NUMBER
8897
Direction
S
STREET_NAME
PRIEST
STREET_TYPE
LN
City
FRENCH CAMP
SITE_LOCATION
8897 S PRIEST LN
RECEIVED_DATE
12/3/1968
P_LOCATION
LEONARD CLAUSSEN
Supplemental fields
FilePath
\MIGRATIONS\P\PRIEST\8897\68-1035.PDF
QuestysFileName
68-1035
QuestysRecordID
1902776
QuestysRecordType
12
Tags
EHD - Public
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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ----- ------�•----- --------c --- w�-/ate <br /> ---- (Complete in Triplicate) Pe <br /> - rmit No. � <br /> --_______ _________ <br /> 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 <br /> described. This application is made in compliant ith County Ordinance No. 549 and ex�ingRules and Regulations: <br /> JOB ADDRESS/LOCAT N ._-. _ � - �,,.�� ACT ----------------------_ <br /> �`. ,p -- <br /> Owner's Name "�J ------------------ -------------------Phone <br /> Address -_ <br /> �� f - ----- _ City <br /> Contractor's Na"'°`-fir' - - - &4cense # 2/ (4�� <br /> --- Phone ----------------- •-•--------- <br /> Installation will serve: Residence F] Apartm nt House❑ Commercial ❑Traller Court I❑ <br /> Motel ❑Other f <br /> Number of living units:__-------- Number of bedrooms ----1------Garbage Grinder -------- --- Lot Size ---__- <br /> Water Supply: Public System and name ------------------------------------------------ __-----_--___-------___Private <br /> ---------------------------------- <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ <br /> Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type ---------------______--_--- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) p� <br /> PACKAGE TREATMENT [ ] . SEPTIC TANK S!? -- r rt <br /> -- �--�--�----�--�--------- Liquid Depth --f <br /> Capacity f- Type ,w1---n.6[[•Material_- No. Compartments p ---------------------- <br /> Distance to nearest: Wel! -' + ---_� _ Foundation f <br /> ---------- Prop. Line ------ <br /> LEACHING LINE No, of Lines --- ------------------- Length of each line------ r .......... Total Length __; _. ----------- <br /> D' Box Type Filter MateriaF. _- ---Depth Filter Material --------------------- <br /> Distance to nearest: Well _�--- }- ------- Fou ation 1-1---------------- Property Line ------45--_----.-.•.- <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No (3 <br /> Water Table Depth ------------------------------------------------Rock Size -------------------------------- <br /> Distance to nearest: Well ---------------------------------- ----Foundation -------------------- Prop. Line --.-------------•---.• <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) <br /> Septic Tank (Specify Requirements) ------- -- --------------------------------------------------------------------------------------------------- <br /> Disposal Field (Specify Requirements) -------- - ---------------- --__----_--_----- <br /> ----- ------------------ - - - -- - <br /> ------------------- --------------------------------------------------- - ----- <br /> - --------- - -------- <br /> - --- ----------------- --- -------------------------------------- <br /> ------ ------------ <br /> ----------------------------------------------------- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: - `• � i <br /> "I certify that i the performance of the work for which this per it is issued, I shall no;employ any person in such manner <br /> as to bec u I ct man's sa ' ornia. :+ <br /> Sign Q- " <br /> BY ---------------------------------' ---------- --- - -- ---- ----L Title ----------------------------------------.-- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -- ------ -----------_- ------ . DATE ----- - - - ------------------- <br /> --------------- -------------------------------------------- <br /> BUILDING PERMIT ISSUED ------------------------ ---------------- --------------DATE <br /> -------------------------------------------------- ---------------------------- <br /> ADDITIONAL COMMENTS --------------------- --------------------------------------------------------- <br /> --------------------------------------------- - - <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ------------- -- <br /> ------------------------------------ --- <br /> Final Inspection by: --- - -r_--- <br /> -- ------Date ---..-% ----------- <br /> ` ------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'b8 Rev. 5M <br />
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