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77-384
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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SAN MATEO
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4200/4300 - Liquid Waste/Water Well Permits
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77-384
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Entry Properties
Last modified
5/24/2019 10:12:45 PM
Creation date
12/1/2017 7:50:11 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
77-384
STREET_NUMBER
3519
STREET_NAME
SAN MATEO
City
STOCKTON
SITE_LOCATION
3519 SAN MATEO
RECEIVED_DATE
05/05/1977
P_LOCATION
DENNIS SCHANZENBACH
Supplemental fields
FilePath
\MIGRATIONS\S\SAN MATEO\3519\77-384.PDF
QuestysFileName
77-384
QuestysRecordID
1914123
QuestysRecordType
12
Tags
EHD - Public
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i <br /> FOR OFFICE USE: j FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> -Pv Permit No._ .7f <br /> i 3�__ <br /> (Complete in Triplicate) <br /> Date Issued-_! S2t-"71 <br /> ---------------- ---------------------- i.-._.-. . This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San JobquipLocal-Health District fora permit to-construct and install the work herein described. <br /> This application is made in compliance with County Ordinance Nq. 549 and exist` g Rules and Regulations: <br /> 7p <br /> JOB ADDRESS/LOCAT N /: ------------ ---CENSUS TRACT----------- - ---- -------------- <br /> Owner's Name-------- -------------- - ---- - ----------.---------------- - ------=--- Phone-4462--- 4 <br /> °. ,. - ----------- -- - --- . - <br /> Address-------------------[---------- ------ --.-------------------- ` 4 � <br /> --. � City-- - --------- - ---------------- Zip - ----------------- <br /> Contractor's Name--------_______ti----:A______.r �_---- License# :S�f _ Phone_- In •��_ _.__. <br /> ------ <br /> l <br /> Installation <br /> will serge: Residence Apartment House-❑-4 40 'Commercial ❑ Trailer Court ❑ <br /> Number of _ Motel ❑ Other '= i = I- --- ---- t <br /> g � s �i f f <br /> living units:__.___ . __Num <br /> ber of,bedrooms--___.Garbage Grind ;_Lot.5ize__ Q_= fir - J.---_,._:-_. ' <br /> Water Supply: Public System and name --- ------ "----------=------------- Private ❑ <br /> p ❑ ❑ ` � y❑^� P n Sandy4Loam ❑ Clay Loam t <br /> Hard an Adobe FillMateripl_:___:-�-_-If es : <br /> } 1 <br /> Character of soil to a depth of feet: " Sand Silt Cla Pea y y/ type t <br /> (Plot plan, showing size of lot, location of system in relation to-wells, buildings etc. must beiplaced on reverse side.) <br /> NEW INSTALLATION: .(No septic tan 0or'seepage pit permitted if pub]Vc_sewer'is available within 200 feet,} <br /> PACKAGE TREATMENT [ ] SEPTIC TANK-)']•" -'" F Sizeµ --;. -------------_Z-------------Liquid Depth.___________ 3_-__- <br /> Capacity. _. . -.�.-�TYPe-= --- - Materia - Na: Compartments----------- ------ ------------ <br /> Distance,to.nearest: Well _------- ---- - - --foundation ------------------Prop. Line : -- - <br /> LEACHING LINE [•] No. of Lines . - ._�_ .__ ____.3-__ 'Length of each line.__'_'_ Total Length----------"------ <br /> k <br /> D' Box Type Filter Material: __ __Depth�Fi ter Material_._.___ _____ _. <br /> s , } ,.r ,.�. ..#, <br /> Distance to nearest: Well--------- t ---Foundation-------------------_ _________Property Line--------._--- -_ <br /> SEEPAGE PIT [ ] - Depth_' -_ t.._-Diameter _._--_ ----Number _ t_ Rock Filled Yes ❑ No <br /> TWaterTable Depth-------------------------t, - .-.Rotck Size <br /> ;-------i ----------------- --------------------- <br /> i <br /> o <br /> :___ = =-�C. <br /> Distance.to nearesf:-Well-_- ----------- ------------- ion <br /> ---------------------------Prop. ]Line- __ --____ -- <br /> s <br /> REPAIR/ADDITION (Prev.'Saritation'Permit#---� _--_'__________________ Date---- i- ----------------------- =----- ----- <br /> Septic Tank.(Specify•Requirements) -• ' j <br /> , <br /> __� x,� •r�� :G[J ----�,�-0---- -�i--- --. <br /> r <br /> : <br /> -----------------2 ie (Specify aquirements} 1 <br /> ------------------------------------- ---------- <br /> ---• - --------------------------------------- ----------------- <br /> -------------- --------------------------- --------------------------------- ---- -------- -- - ------------------------------------ --- -- ---- <br /> - i <br /> _ I <br /> f ' [Draw existing and required ddition 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 County <br /> Ordinances, State Laws, and Rules and Regulations of the' San Joaquin Local Health District. Home owner or licensed agents <br /> signature certifies the following: t <br /> "I certify that in the rformdnce'of the"work for which this permit is issued,'.I shall'not employ any person in such manner as <br /> to become ubje t4/Work n's C pe tion laws of California." <br /> ` /tet a <br /> Signed--- L --Gwmel vi <br /> BY" Title' -*^= <br /> - ---- ---- - - <br /> 6 <br /> ] (If othef than owner) # <br /> FOR DEPARTMENT USE ONLY 3 { <br /> APPLICATION ACCEPTED? BY- ---4 - ------------------------------------------DATE------ -77-7------- <br /> DIVISION <br /> - ---DIVISION OF LAND NUMBER-..----------- -------- ---------------- --- --- -------- --------------------------------------------DATE------ ----------- ------------------------ <br /> ADDITIONAL <br /> --------- - ---ADDITIONAL COMMENTS ------------ -------------------------------=--------------- ----------------------- <br /> a <br /> ---------- ------------------------------------- -------------- ----------- --------------------------------------------------------------------------------------------------------------------------- <br /> I <br /> ----------------- -------- ----- --- <br /> - ---- ---------------------------.--..._---------------------- ---. <br /> - ------------------- ---' -------------- - - ------ ---- ---- ------------- - ---------- --- #� <br /> Final-Inspection by- / == -- -- ------- ---- " Y = ry Date.---- <br /> EH 13 24 / SAN JOAQ N LOCAL HEALTH DISTRICT 'ZY F&5 21677 RE` <br />
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