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22314
EnvironmentalHealth
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VON SOSTEN
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16298
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4200/4300 - Liquid Waste/Water Well Permits
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22314
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Entry Properties
Last modified
1/9/2019 10:11:06 PM
Creation date
12/1/2017 11:05:19 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
22314
STREET_NUMBER
16298
Direction
W
STREET_NAME
VON SOSTEN
STREET_TYPE
RD
City
TRACY
APN
20920006
SITE_LOCATION
16298 W VON SOSTEN RD
RECEIVED_DATE
09/12/1967
P_LOCATION
MISSION CONST CO
Supplemental fields
FilePath
\MIGRATIONS\V\VON SOSTEN\16298\22314.PDF
QuestysFileName
22314
QuestysRecordID
1971788
QuestysRecordType
12
Tags
EHD - Public
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FOR OFFICE USE: <br /> ------ <br /> APPLICATION FOR SANITATION PERMIT Permit No. ........... <br /> ---- ------------ ---------------- ------ (Complete in Duplicate) �1 <br /> - -------- ---- ..----.-. - ..-. This Permit Expires 1 Year From Date Issued Date Issued - -------------------- <br /> I Application is hereby made to the San Joaquin Local Health District for a permit to con struct_and-insbll the,work herein described. <br /> This application is made in compliance with County Ordinance No. 549. ' ;2' -$,°.Y✓ �-fir <br /> JOB ADDRESS AND LOCATION.. -------------------- - _ m " <br /> Owner's Name--------��---- ..... _.-. _,cl---- - - g� --- <br /> Address <br /> - Phone - ------ - <br /> t <br /> Address------------ �'' f __..._7 '--------- -•---��+..J_. ------------------------ --_ ----------------_.--.--..... -----------.-------- <br /> '���------- ------I——--------- -------------------- Phone-- •" �� <br /> Contractor s Name-__-. / <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -------- Number of bedrooms.- Number of baths __2--Lof size ----- - f <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. 4E;% <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: {if yes,date--------------_---.I No ❑ New Construction: Yes E�` No ❑ FHA/VA: Yes ❑ No �yaP <br /> TYPE OF, INSTALLATION AND SPECIFICATIONS: <br /> {No septic tank or cesspool Qermitted'ifpublicblic sewer'rii, aavailable within 200 <br /> Septic Tank: Distance from nearest well-/ -Distaancefrom foundation la_!� l <br /> ___Materia -- '-____-_-_ 1 <br /> No. of compartments-._____-�_________-_Size----tjl_6 -` _-_------.Liquid depth----------Y-----------Capacity....Zo?0 Disposal Field: Distance <br /> of {ineseares�lX��--LDentgth of from <br /> line�o%���_-'�_-.Widthcofttrench est-I�line_____�� <br /> from <br /> ------ ------ <br /> Type of filter material__ // Depth of filter materia!___re �% �fotal length-.-- �- <br /> --- ----.- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_- 1----------., <br /> ❑ Number of pits----------*-----------Lining material-----------------------Size: Diameter----•---- ............Depth_------------------_------------ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-----.------------- Lining material---.--.-----------------:---_.-------. <br /> ❑ Size: Diameter ---------- ---Depth----------------------------------------------------Liquid Capacity----------------------------gals. kl <br /> Distance from nearest <br /> building <br /> Privy: Distance from nearest well -- ----------------------------------- 9 -------------------------------------- <br /> ❑ ' <br /> Distance to nearest lot line---- -----------------------------------------•------------------------------------------------------- -------- ---- - - <br /> Ir <br /> Remodeling and/or repairing (describe)----------------------•----------- ----------------------------- -----•------•-•---•--------•--------------------------•------------------------- <br /> ------------------------------- ---------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------- r <br /> -------------------------------------------------------------------•--•------------------------------------------------------------------------------------------------------------------•-----------------------=------------ <br /> ------------ - - -- ---- ..-------------------—---p------------------pp-----------------------------------------------:-------------------.-----------—----------•.--- - --------------------- <br /> I hereby certifythat I have prepared this application and that the work will be done to accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> {Signed)--4, , - 1 {Owner and/or Contractor) <br /> -Pla Ian, showing size of lot, location of system : relat n to wells, buildings, etc. ITi#le)--"- - " - — rt� __a- <br /> _ -Zion <br /> ( p g y g , can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----- -------- ----- DATE-_-__._ _--=I�-�1 <br /> -- - -- ------ ------ ----------------------- ---- ------------------ - <br /> REVIEWEDBY----------------------------- ------- ------ ------ -- ------------------------------------------- DATE----------------------------------------- <br /> BUILDING PERMIT ISSUED-------------------------- j --------------•----------------------- DATE--------- --------------------------- �. <br /> Alterations and/or recommendations:.-..- - �1/,Q ` `L !!x� ---------------•-----_---------------------------- -- --- ------- <br /> - ------ -----------------------------------------------•---------------------=---------------------- ----------------- ---- <br /> �3 7 <br /> FINAL INSPECTION /_ Date.------ ------- - -----.---.' <br /> A AQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haze ton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Lodi,California Manteca,California Trac <br /> Stockton,California Y,California <br /> r w <br /> F.P.0 O. <br />
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