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72-202
EnvironmentalHealth
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HEINTZ ALLEY
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3053
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4200/4300 - Liquid Waste/Water Well Permits
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72-202
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Entry Properties
Last modified
3/3/2019 11:14:58 PM
Creation date
12/2/2017 3:25:18 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
72-202
STREET_NUMBER
3053
Direction
E
STREET_NAME
HEINTZ
STREET_TYPE
ALLEY
SITE_LOCATION
3053 E HEINTZ ALLEY
RECEIVED_DATE
2/21/1972
P_LOCATION
MAXIN HOLLINGSWORTH
Supplemental fields
FilePath
\MIGRATIONS\H\HEINTZ ALLEY\3053\72-202.PDF
QuestysRecordID
1748849
Tags
EHD - Public
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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT -v <br /> Permit No. <br /> ------------------- <br /> (Complefe'sn Triplicate) <br /> ------------ <br /> ----------- -------------- <br /> Date Issued -----'--------�---. <br /> ------------------ <br /> ___ ____ ------------- <br /> This Permit Expires 1 Year From Date issued <br /> Application ;s hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> Regulations- <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> e.��- $ ''� CENSUS TRACT .-----------�---j-------9------ <br /> JOB ADDRESS/LOCATION ------- - Phone k--rf--"`- 7—,Y- ---- <br /> .111/ �1 --- ---------Owner's Nom ---�- �-�-�-- --- ----�d--�'--�`'-l-r�-- pe <br /> City ------------A.�-� m.- P.6 ------•---•---------------•---•-- <br /> 1 -----1: x-- r `� <br /> Address Phone . l <br /> Contractor's Name ----�-�./ --�.�----C�--�-��-�-�- --T���-- - --.License # <br /> ial ❑Trailer Court El <br /> Installation will serve: / Residences Apartment House❑ Commerc <br /> Motel ❑Other -------------------------- ----- <br /> --_ <br /> Number of living units:-- Number of bedrooms --- -!V-------. Garba-ge Grinder ---- Lot Size--- <br /> - private El <br /> Water Supply: Public System and name ------------- <br /> _ <br /> Cl Peat❑ Sandy Loam Clay Loom ❑ <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Y ❑ A <br /> Hardpan ❑ Adobe-0 til{ 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 side.) i <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> i ! <br /> SEPTIC TANK'[ ] `. Size-- - Liquid Depth <br /> PACKAGE TREATMENT [ ] <br /> Capacity ------- ------ -- YP No. Compartments . <br /> T e -------------------- Material------------------ - W <br /> Distance to nearest: Well ------------------------------------Foundation ------------------ <br /> --- Prop. Line -------•-------------- ` <br /> .-- Length of each line---------------------- ----- Total Length ------•-----•------••------- <br /> tEACHING LINE [ ] No. of Lines --------------------- g <br /> 'D' Box -__-- ----- TYPe Filter Material -_.-----------------Depth Filter Material -------------------- <br /> --- Foundation .----------------------- Property Line --•----- <br /> ---------------- <br /> Distance to nearest: Well ----_-------- ----- <br /> -- Diameter ---------------- Number --_ Rock Filled Yes C] No 0 <br /> SEEPAGE PIT [ ] Depth ----------------- <br /> ------------------------- <br /> Water Table Depth ------------------------------------------------Rock Size ------------------------ <br /> Distance to nearest: Well -------------------------- - <br /> ----- -----Foundation -------------------- Prop. Line ------------ ---------I <br /> - <br /> _ j <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ------------- ------- -------- - -- -- - <br /> Date --------------------------------- .r, <br /> Septic Tank (Specify Requirements) ------------- <br /> Disposal Field (Specify Requirements) -- ---= ---- <br /> -- --------- - <br /> - <br /> _ _ _{Draw existing and required addition on reverse side) <br /> ared this application <br /> I hereby certify that I have prepRegulationso <br /> ance <br /> San <br /> of the San Joaquin Local Health Distrhat the work will be done in ict. m <br /> Hoete ownor le <br /> d Reg er, <br /> County Ordinances, State Laws, and Rules an <br /> sed agents signature certifies the following: <br /> for which this permit is issued, I shall not employ any person in such manner <br /> "I certify that in the performance of the work <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ---- ---- --- - ------- --------------------------------------- Owner-------- � � <br /> C�� .�{,� ----- Title ----�-o�.� -- - <br /> ------ - <br /> ------------------- <br /> By <br /> •-�'v ��" <br /> (I other than ner) <br /> FOR DEPARTMENT USE ONLY <br /> 2/'7 <br /> APPLICATION ACCEPTED BY ---- -- -'--------- ----------------- ------------ <br /> ----------DATE ---- -- --------------- DATE ---- '------ <br /> -------- -------------- <br /> BUILDING PERMIT ISSUED -------------------- <br /> ----------------------------- <br /> ---- - <br /> ADDITIONAL COMMENTS ------------------ ---- ------------------------------- <br /> ------ --- ----- --- <br /> ------- --- ----- ---- - - --- ------ - -- --- <br /> - ---------------- ------- -- --- -------- -------- - --- - -- - --- ----- .- - --- <br /> ----------------------- - - - - - � �� <br /> ----------- ------ - --- ----- --- <br /> -- -- <br /> Date � <br /> Final Inspection b SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />
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