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SU0007601_SSNL
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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88 (STATE ROUTE 88)
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17436
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2600 - Land Use Program
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PA-0900031
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SU0007601_SSNL
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Entry Properties
Last modified
11/20/2024 9:22:01 AM
Creation date
9/4/2019 6:17:35 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
FileName_PostFix
SSNL
RECORD_ID
SU0007601
PE
2691
FACILITY_NAME
PA-0900031
STREET_NUMBER
17436
Direction
N
STREET_NAME
STATE ROUTE 88
City
LOCKEFORD
APN
05125012 13
ENTERED_DATE
2/24/2009 12:00:00 AM
SITE_LOCATION
17436 N HWY 88
RECEIVED_DATE
2/23/2009 12:00:00 AM
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\E\HWY 88\17436\PA-0900031\SU0007601\SS STDY.PDF \MIGRATIONS\E\HWY 88\17436\PA-0900031\SU0007601\NL STDY.PDF
Tags
EHD - Public
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FOR OFFICE USE: ..' .PPILICATION FOR SANITATION Plir )T ..... L <br /> � <br /> >... -•-------- (Complete in Triplicate} <br /> ...... �, Permit No. .. _� <br /> s <br /> This Permit Expires 1 Year From Date Issued Date Issued .....................•--•----•-. <br /> /6:" - <br /> IG y <br /> Application is hereby made to the San Joaquin Local Health District for a per 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/LOCATION ...-- ------7.10 <br /> .. CENSUS TRACY <br /> Owner's Name .....A ------ ._- _._ .ma c......_.. - , Phone _ <br /> Address ........... _ .....�Q.... ._ ....' _. ......_. City G. ........... <br /> -� ........................... .::............License # _1 _.__._:._ Phone .............:..... <br /> Contractor's Name ____ �'�$ -._..r <br /> Installation will serve: Residence [Apartment House-E3 Commercial ❑Trailer Court 0 <br /> Motel ❑Other ........................................... <br /> Number of living units:..__ __. Number of bedrooms __....Garbage Grinder ............ Lot Size -------- _f_________.___----------------- <br /> Water Supply: Public System and name ...............................................................................................................Private ❑ <br /> Character of soil to a depth of 3 feet: Sand❑eAilt❑ Clay ❑ Peat❑ Sandy loam ❑ Clay Loam ❑ <br /> Hardpan Tf Adobe ❑ Fill Material ............ If yes,type ............................ <br /> (Plot pian, showing size of lot, location of-system in relation to wells, buildings, etc. must be placed on reverse side.I <br /> NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ SEPTIC TANK 13 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 /> Fill, <br /> Distance to nearest: Well .------ .----:--. Foundation ........................ Property Line ........................ <br /> SEEPAGE PIT [ j Depth ...... Diameter ................ Number ....................... Rock Filled Yes ❑ No <br /> Water Table Depth ------------------- ............................Rock Size ----•-•-----.. ................. C' <br /> Distance to nearest: Well........................................Foundation ._...._............. Prop. Line ...................... <br /> I <br /> REPAIR/ADDITION(Prev. Sanitation Permit --------•----------------------------------- Date ............................. <br /> .....� <br /> Septic Tank (Specify Requirements) ----------------------------------------- -•------•---- ------- ------- -- .........----•-------------. . <br /> Disposal Field (Specify Requirements) ..... ..------...... .... ...: ... ............................. <br /> F! ......... <br /> --------•-------------------------------- ------------------------------------------_ ---------------------------------......-................. <br /> ._..__....... <br /> ..._.................. <br /> (Draw existing and required addition on reverse side) <br /> F <br /> I hereby certify that I he prepared this application and that the work will.be done in accordance with San Joaquin <br /> County Ordinances, Stateav3.aws, and 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, 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 /> drl y �� ------ <br /> Bim? ' '.....__�:.r__ Title .............................. -------------------------------------- <br /> F <br /> = <br /> .l (If other than owner] <br /> FOR DEPARTMENT USE ONLY <br /> FAPPLICATION ACCEPTED BY -----------��----------------•----------...................................... ........ DATE ......I.-�...c? _T .._..... <br /> BUILDING PERMIT ISSUED _ DATE --•.......................:.......•---•-_-. <br /> ADDITIONAL COMMENTS _.......: <br /> ----------------------•-•------....-•-•---.- ...................................... ...................................... .......... ......._........_ .............. <br /> ----------•----- - -- ------------------••-•--------------•-------------• .......... ---._._........_... --• -------•----•--•- <br /> ...._. <br /> .............. <br /> Final Inspection by ..----- �r _... .............. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E_ H-1.3 24 1.`69 Rpv. 5M 71723 M <br />
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