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73-1120
EnvironmentalHealth
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SCOTTS
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4200/4300 - Liquid Waste/Water Well Permits
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73-1120
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Entry Properties
Last modified
3/28/2019 10:07:18 PM
Creation date
12/1/2017 8:22:32 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
73-1120
STREET_NUMBER
1825
Direction
W
STREET_NAME
SCOTTS
STREET_TYPE
AVE
City
STOCKTON
SITE_LOCATION
1825 W SCOTTS AVE
RECEIVED_DATE
12/11/1973
P_LOCATION
E ROWE
Supplemental fields
FilePath
\MIGRATIONS\S\SCOTTS\1825\73-1120.PDF
QuestysFileName
73-1120
QuestysRecordID
1917810
QuestysRecordType
12
Tags
EHD - Public
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FOR OFFICE USE: <br /> 30 APPLICATION FOR SANITATION PERMIT <br /> ........ (Complete.:............................ (Complete in Triplicate) Permit No. ...�. <br /> ............................. Th€s Permit Expires I Year From Date Issued Date Issued .0:. �_�73 <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 compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> J08 ADDRE55/LOCATi0N /r�f cJ _..C�l� <br /> �6 ..................• ........CENSUS TRACT <br /> Owner's Name ........ e..--•................ Phone <br /> ...... ............•---••........_......... <br /> Address §547/wems...............•... ...... City n{•c' �!7 <br /> Contractor's Name P .•f?_____________a427e„................................License <br /> Installation will serve: Residence (gApartment House❑ Commercial ❑Trailer Court <br /> Motel ❑Other .......................... <br /> Number of living units:./.,..... Number of bedrooms ..__..Garbage Grinder. - Lot Size 4 A_ <br /> Water Supply: Public System and name ... ,4/127... i!.... .....____. .••Private ❑ <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 sine.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,} <br /> PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size................--------------•••-.-•-----..--._ Liquid Depth .................. <br /> Capacity -- -------- ------- Type --------------- Material--.---------., ._... No. Compartments <br /> Distance to nearest: Well ............ . . ... .... . Foundation ....................... Prop. Line ..................--.. <br /> LEACHING LINE [ ] No. of Lines ........................ Length of each line-------._.................... Total Length <br /> 'D' Box .......... Type Filter Material ....................Depth Filter Material <br /> Distance to nearest: Well ........................ Foundation .................. Property Line ....... V1 <br /> SEEPAGE PIT [ ) Depth ------------------.. Diameter Number __....:..................... Rock Filled Yes ❑ No C] s <br /> Water Table Depth Rock Size <br /> Distance to nearest: Well ........................................Foundation ................... Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# .......................................... Date <br /> Septic Tank (Specify Requirements) ................... .................. ... <br /> - <br /> • <br /> Disposal Field (Specify Requirements) .-� -- ------ !- .r.. . - �f•._.�rz,c /_-_ .. <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. }lame owner at licen- <br /> sed agents signature certifies the following: <br /> "I certify_that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California.” <br /> Signed ......``.._------ ...----• Owner <br /> By ..... .................... . ....... Title 2. 0v,,!A!r! /Idol` .- <br /> ---------------------------------- <br /> (If er than owner} ---"'- ' <br /> FOR EPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ........C.:.. ............. DATE ...�..2--�1 ' 3 <br /> ----...-•----------•-----••-----•--- ......... -••---•--......... <br /> BUILDING PERMIT ISSUED ............................... ...........................DATE __........ ........................ <br /> ADDITIONAL COMMENTS ................... <br /> Inspection by; ...... <br /> p .:...... <br /> Final Ins .Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT X14. <br /> E. H.13 24 1-'68 Rev. 5M 7J 72 3 .K <br />
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