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73-112
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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VINE
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27755
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4200/4300 - Liquid Waste/Water Well Permits
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73-112
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Entry Properties
Last modified
3/28/2019 10:07:12 PM
Creation date
12/1/2017 10:51:28 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
73-112
STREET_NUMBER
27755
Direction
E
STREET_NAME
VINE
City
ESCALON
SITE_LOCATION
27755 E VINE
RECEIVED_DATE
03/07/1973
P_LOCATION
IRV STARK
Supplemental fields
FilePath
\MIGRATIONS\V\VINE\27755\73-112.PDF
QuestysFileName
73-112
QuestysRecordID
1969793
QuestysRecordType
12
Tags
EHD - Public
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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> - <br /> - <br /> ----------------------------------------------------- <br /> Permit No: <br /> (Complete in Triplicate) <br /> ___�----`---____- <br /> ----------------------------- ---------------------- <br /> �1Date Issued ----J"0~_73.. <br /> x ------ This Permit Expires 1 Year From Date Issued i <br /> App1.i a io`n-is here*"V made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. Thi,'s application is made in compliance with County Ordinance No. 549 .and existing Rules and R6 gulations: <br /> JOB ADDRESS/LOCATION .---27 .? _------�f=-- ---------------CENSUS TRACT _J�-t ----------- <br /> tI - <br /> Owner's Name 1 V[R ' Phone �.1... <br /> Address - -------- ----27� l �F- =------------------------------- City --- -- _ 19-L-ol ------------ <br /> ` r K .._._...._ <br /> Contractor's Name 19TTERT3_11_� ZPFWF-f�----t_�1Nj_�_.License # ------------ ---------- Phone ....... -__-___ ' <br /> Instdllationw`li 1 serve: Residence P<Partment House❑ Commercial ❑Trailer Court i❑ <br /> p .iN_ otel ❑ Other -------- ----------------------------------- f <br /> Number of livingunits:._`.____._ Number ofbedrooms /�______Garba e Grinder L -coo <br /> ----------------------------/------- ---------------------------------------: Pr nate <br /> Water Supply: Pblic System and name ------------------------� g Lot Size <br /> Character of soil to a depth of 3 feet: Sand'0 Silt 0 Clay ❑ PeatSandy Loam ❑ Clay Loam; <br /> Hardpan /Adobe ❑ Fill Material ❑o-_ If yes,type ----------__________ <br /> i w <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc—'must 'be placed on reverse side.) V <br /> NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is av}ailable.within 200 feet,} .� <br /> PACKAGE TREATMENT [ I SEPTIC TANK[ Size----------------------------------- Liquid Depth __ __y-_J...... (� <br /> Ca -----------"��------------- Type ---=---------------_ Material o. Compartments <br /> �! <br /> p tY Yp p ; ----------- (�• <br /> Distance to nearest. Well ------------------------------------Foundation ___-- ----____________,Prop. Line ---_--------------.-. <br /> X ._S,I } 3r, V �! <br /> LEACHING LINE [ No. of Lines ------------- Length of each line------------------------ __ Total.-i_-ength ----------- ____________ n` <br /> D' Box ------------ Type Filter Material --_----__ p 1 <br /> De th Filter . atenal_ -- '' <br /> Distance to nearest: ell ___:__________________ Found afion; _ -------- : _._ ropertyW Line -_ _. "___ ------------ <br /> SEEPAGE PIT [ ] Depth -------------------- iameter ___________'___ Number __ ------ Rock Filled Ye C] Na C] <br /> Water Table Depth -- ------(---- -----------=-----------------Rock Size -------- ------------------------ <br /> Distance <br /> ------------ =---••---Distance to nearest: VV ---------------Foundation -{- ------------ Prop. Line ---------s......-•.... _ <br /> 1 i <br /> REPAIR/ADDITION(Prev. Sanitation Permit# - ____.--____-------------- ------------- Dat\______________ <br /> % ________________ <br /> Pt (Specify Requirements) <br /> } - <br /> ---------- <br /> Disposal Feld (Specify Requirements) __- f � _---R2f <br /> ------'- <br /> ---- <br /> - - -------- <br /> 'T--- -------- AFR_P` T _� - <br /> X J� ` r-------------------------------- <br /> ------ <br /> OF�.P4.6 _----- — -------- --- v <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: y <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 beco W ;kman's CoMpensati.on laws of California." I I <br /> Signed ------. Owner 3 r <br /> C'7 Title -----------------------f--------------------------------- ----- <br /> f lerthan iownerf <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED�.BY ...... ------------------------------------------------------------ DATE ---------3-=__-7 ~-73--._.. <br /> BUILDING PERMIT ISSUED :'-------------------- ------------------------------------------------- ---------------------------------DATE -------------.------"----------�---_.--- <br /> ADDITIONAL COMMENTS -- ,- —�- r = �. r..._�r_ ¢-.w_.,._s_z ._ _ ------------ --------- <br /> ------------------------------------- -------- -- ---------------------- n. _ -- <br /> t!� _ = `-_ <br /> -------------------------------------------- ------- - ------------------------- --- ------ ----- - -------------------------------------- -------------------------- ------ <br /> Final Inspection 7 <br /> Date ------------------- -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. --- <br /> H. 9 1-'66 Rev. 5M <br />
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