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4681
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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4681
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Entry Properties
Last modified
1/25/2019 12:25:40 AM
Creation date
12/2/2017 4:43:33 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
4681
STREET_NUMBER
4115
Direction
E
STREET_NAME
HORNER
SITE_LOCATION
4115 E HORNER
RECEIVED_DATE
12/10/1953
P_LOCATION
WILLIAM A TICER
Supplemental fields
FilePath
\MIGRATIONS\H\HORNER\4115\4681.PDF
QuestysFileName
4681
QuestysRecordID
1757737
QuestysRecordType
12
Tags
EHD - Public
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APPLICATION FOR SANITATION PERMIT Permit No. _ ----- <br /> (Complete in Duplicate) <br /> Date Issu ---------- ..... <br /> �J` T <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construe end ia#alljthe work�ti a rein described. <br /> This application is made in compliance with County Ordinance No, 549. <br /> JOB ADDRESS AND LOCATION----- <br /> .......... . weIV-------- <br /> - --- -------------------------------------------- <br /> Owner's Name------ .. .... _t_-------7-7--o-E; ------------------------------------- Phone.57_7r 7 <br /> Address------------------ --- ----------------- ---------------------------------------------------------------- <br /> Contractor's Name------____-- - <br /> 11 --------07,------------------ <br /> ----- __ , - . - — �, <br /> - ---- ----------------- ------ ------------------------------- -------- Phone. ' --------------------- <br /> Installation will serve: Residence X Apartment House [] Commercial E] Trailer Court El Motel El Other [__1 <br /> Number of living units. __1---- Number of bedrooms .I--__- Number of baths -/---- Lot size -K-L! ___________________________ <br /> Water Supply: Public system %, Community system El Private F1 Depth to Water Table #_$_ff. <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel E] Sandy Loam E] Clay Loam E] Clay [] Adobe Hardpan E] <br /> Previous Application Made. Yes 0 No g- New Construction: Yes 0 No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well________________Distance from foundation--------------------Material------------------------------------------------- <br /> 7 No. of compartments-------------- -----------Size-...----------------------------Liquid clepth--------------------------Capacity----------------------- <br /> Disposal Field: Distance from nearest well________________-Distance from foundation--------------------Distance to nearest lot line___-__- --------- N <br /> El Number of lines----------------------------------Length of each line-----------------------------.Width of trench----------------------------_--_--- N <br /> Type of filter material---------------------- --Depth of filter maferial-----------------------Total length-.______________________----_-__-_-______ <br /> Seepage <br /> ength------------------------------------------ <br /> Seepage Pit: Distance to nearest well/'?16_7tF—_ __Disfance_froq fo <br /> yndation__/ -------------Distance to nearest lot line---/4!------ <br /> If---------- ---- I <br /> Number of ---Lining material__0:i&t_4C&_.Size: Diamefer-Z-3... Depth___`. --------- ----- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material__.._______-____.._.______---_._-.___ - <br /> F1 Size: Diameter---- ----------------- ---------------Depth----------------------------------------------------Liquid Capacity- --------------------------gals. <br /> Privy: Distance from nearest well--------------------------------------------------Distance from nearest building____-.____ ____------_-__...._. <br /> ❑ <br /> uilding------------------------------------------ <br /> F1 Distance to nearest lot line------------------------------------ ------------------------------------------------ <br /> Remodeling and/or repairing (describe):_.____.-_ ----va <br /> ---------------------------------------------------------------- �,e--------- ------ ----- ------- <br /> --------------------------------------------------------------------------------__---------------------------------------------------------------------------------- --------------------------------- <br /> I------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----- ----------------------- <br /> I hereby certi,#j t :,prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State I ws, d r es and ions of the San Joaquin Local Health District. <br /> aw regou n <br /> (Signed------------ ------- --- -- - -------- <br /> -------- ---- <br /> By:.-- <br /> --- ---------------------- ------------------------------------ ---- wrier and Co tractor) <br /> By. ......... <br /> ........ -- -- -----------------cl�;;------ - -- ---------- -----------(Title)------- ---- - -- ----- <br /> rs, side}.{Plot plan, showing size of lot, location of system in re Aionto wells,�buildliings, etc., can be place-- on reverse side. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------------------------------------------/v', <br /> ------------------ ----------- DATE----------- <br /> ------------- <br /> REVIEWEDBY--------------------------------------------------------------------------------------------------------- ------------ DATE <br /> BUILDING PERMIT ISSUED---------------------------------------- ---------------------------- ------------- ----------------- DATE------ -------------------------------- <br /> Alterations and/or recommendations:--------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------- ---------------------------------------------------------- ----------------------------------------------------- <br /> --------------------------------- ------------------------------------------------------------------------------------------I------------------------------------------------------------------------------------------ <br /> ----------------------------------- ---------I------------ ------------------------------------ -------------------------------------------------- ------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------------- -------- ------------------------------------------------------------------------------------------------------ <br /> ......... --------------------------------- <br /> FINAL INSPECTION BY:----------------- Date <br /> - --------------------------- ------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M io-52 Revised W-2100 <br />
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