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74-1086
EnvironmentalHealth
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THORNTON
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4200/4300 - Liquid Waste/Water Well Permits
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74-1086
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Entry Properties
Last modified
4/8/2019 10:05:57 PM
Creation date
12/2/2017 12:58:21 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
74-1086
STREET_NUMBER
20000
Direction
N
STREET_NAME
THORNTON
STREET_TYPE
RD
City
LODI
SITE_LOCATION
20000 N THORNTON RD
RECEIVED_DATE
12/03/1974
P_LOCATION
ADAM VAN EXEL
Supplemental fields
FilePath
\MIGRATIONS\T\THORNTON\20000\74-1086.PDF
QuestysFileName
74-1086
QuestysRecordID
1946734
QuestysRecordType
12
Tags
EHD - Public
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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) ,r' <br /> Permit No. .7 <br /> ! This Permit Expires 1 Year From Date Issued Dpte Issued <br /> 1 <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 /> JOB ADDRESS/LOCAT ON ,d$0.47:b-. ... . ...... . ... ......... .....,..:.........CENSUS TRACT ......................... <br /> Owner't. Name ... . ..... .... ..:................I............ .. ... .....Phone .............. ............. <br /> Address <br /> 1_La •_ City ... ...•...... .................. . <br /> Contractor's Name . ....... -: .- ..License # �� -�� �� Phone <br /> Installation will serve: Residence LC A artment House❑ Commerclal ;QTrailer Court <br /> tMotel ❑Other ............................................ <br /> Number of living units:............ Number of bedrooms ............Garbage Grinder ............ Lot Size ............................................ <br /> Water Supply: Public System and name ...........................----- -- ---•---- ..........._-_..--------------------- ..........................Private [7� <br /> Character of soil to a depth of 3 feet: Sand❑ . Silt❑ Clay ❑ ' Peat❑ Sandy Loam ❑ Clay Loam ID-� <br /> Hardpan Ej Adobe ❑ Fill Material -._._...._•_ If yes, type __-._---..-.•_______________ Q <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 <br /> PACKAGE TREATMENT [ ] SEPTIC TANK ] Size------------------------------------------------ Liquid Depth ....._...._.. ......... <br /> Capacity l= y ... Material.................. No. Compartments <br /> Distance to riearest: Well ....................................Foundation .._._........... ----- Prop. Line ...................... <br /> LEACHING LINE [ j No. of Lines ------------------------ Length of each line-------------...__.......... Total Length ......................... ' <br /> 'D' Box ....0....... Type Filter Material•....................Depth Filter Material .....__..__.._ ......................... <br /> Distance to-nearest. Well ........................ Foundation _..._........ .......... Property Lina . <br /> SEEPAGE PIT j j Depth ..:... .......:.:... Diameter ................ Number -------------- ....... Rock Filled Yes p No ❑ . <br /> t <br /> • Water Table Depth _.Rock Size <br /> Distance to nearest: Well........................................Foundation .................... Prop. Line ---------------._..-- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..................................I <br /> t <br /> Septic Tank (Specify Requirements) .................:.•----••-••...•--- ------•--.....--- ............. .--•------•••--..__............. .u....-_... <br /> Requirements) <br /> � �� <br /> Disposal Field (Specify Requirements) --rrC. -- ------ -- - --- --- "" '-- -.. "1^-- " ......... <br /> (Draw existing and required addition on reverse side) <br /> r 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, anis Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, 1 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 ................................................. �. . <br /> -- - ---- -------- - ��--_. Title ...--- -._.._ ....... - --- -._..._.._....._. <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .... _ _ .. _:� . .. .................. DATE ..L.�.".�-�-�.�................. <br /> BUILDINGPERMIT ISSUED ..._..--•-••--•-•-------. .....................•--•--•.....•-••-•----••-••••--...__:.....•........DATE . ......................... .............. <br /> ADDITIONAL COMMENTS ...............:..................••-......------....: _........ .... ° <br /> . ..._..... : <br />
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