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6891
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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6891
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Entry Properties
Last modified
2/10/2019 10:20:00 PM
Creation date
12/2/2017 4:50:47 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
6891
STREET_NUMBER
2844
Direction
S
STREET_NAME
HOWE
SITE_LOCATION
2844 S HOWE
RECEIVED_DATE
11/10/1955
P_LOCATION
VINCENT CACHU
Supplemental fields
FilePath
\MIGRATIONS\H\HOWE\2844\6891.PDF
QuestysFileName
6891
QuestysRecordID
1758509
QuestysRecordType
12
Tags
EHD - Public
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APPLICATION FOR SANITATION PERMIT Permit No. _/J-__ <br /> _ (Complete in-Duplicate) <br /> . Date issued .............. <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. 4 <br /> jr <br /> JOB ADDRESS AVID�LOCATION-- - f7__----- °-- - ------------- i <br /> Owner's Name `-- * /?` ---- ------ ----------------------- --------------------------------- --------------------------- -------- - Phone------------------------------------ <br /> T <br /> Address <br /> .... <br /> t <br /> Contractor s' Name------------ ---- -------------- ---- - • -- --- ------------------------------------- Ph6ne----------------------------------- <br /> --- <br /> will serve: R sidence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Ot er ❑ <br /> Number of living units: _;/Zirrmunify <br /> mber of bedrooms ._�__. Number of baths __�____ Lot size _._ zc�_Ip______________________________ <br /> Water Supply: Public system system ❑ Private`,❑' Depth'to Water Table ------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy LoamEl Clay Loam E] Clay E] Adobe a`_H`ardpan F]Previous Application Made: Yes E] No 21,11, New Construction: Yes o ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permittedcif public s er is available within 200 feet.)( <br /> Sept'c Tank: Distance from nearest welL______�_______Distance from foundation_______._.Material__-______-_------------------------------------ <br /> 1_ No. of compartments_.______ _ ____________ ize--------------------------------Liquid Flep h �- ea <br /> Capacity_ <br /> 1 <br /> t Dispos Id: Distance from s well ___ t istance f oundafion_� __ y--_-._- r of lie _ _ . <br /> �. <br /> lines------ Le of each line- ,. - _ __--.Width o nch------- ---t______ <br /> �- -� <br /> Type of filter ma erfaJ?� _ s h? t_ l7epth of filte, material__-_-_1 _. .__ __._Total ength__1_____._____ .> _ <br /> r <br /> Seepa e Pit: Distance to nearest weld_-- - - Distance m fo ndation^��bi/�t ance10 Weares,tlo�t l,ine_ .__ _._ <br /> Number of pits______._____--____Lining material--- ------------------ ize. Diameter------_-C1__Q..___-Depth_-----f- -----k-..____r <br /> Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material------------------------------------- <br /> ❑ - ,Size:..D;iameter------------------------------- ----Depth----•-----------------------------.------------------Liquid Capacity----------------------------gals. 1f <br /> - •,t — -m M- <br /> Privy: Distance from.nearest well---.__----------------------------------------------Distance from nearest building--------------------------------_-------. i <br /> ❑ Distance to nearest lot line------------------------------------------------------------ --------------------•-•------------------------------------------------------ <br /> ----------------- -------- <br /> Remodeling <br /> ------- - <br /> Remodeling and/or repairing (describe):------- ------------` n - ----------------------•__-- -------- <br /> _ <br /> -------- ------ ------ - ---- <br /> .. r�•---•-- ----i- —------ - - d <br /> ---------------------------------------------------------------- .- ------------------------------- - ----- --------------------------------------------------- <br /> hereb -- -G- cf ---------------------------------------- <br /> --------- - -- <br /> y cert ify That I have prepared this application and of the work will be done in accordance with San Joaquin County <br /> ordinances, S# # laws, andrrules nd regula�nsFof the San Joaquin Local Health District. <br /> (Signed) - --- ------ ------= = fi -----------------------------------------(Owner and/or Contractor) <br /> - r- <br /> -------= Title <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings,.e#c:,,can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACC1 PTED .BY ----------------------------------------------------------------------------------------- DATE�.--------------------------------------------------- <br /> REVIEWED BY DATE ------------------------------------------------ <br /> BUILDING PERMIT ISSUED---------- ----- --------------- <br /> ----------------- <br /> ----------------_----------------------------- DATE-.- ^. ----------------------------------------------- <br /> Alterations and/or recommendations:-- ---- ---------•------------•--------------•--••--•-----•-•----------••---------•---------...._..-----------------_----- <br /> ---- ----------------- -- - <br /> FINAL INSPECTION BY--------------- ------------------------------- Date------ -/. - ------ <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 i <br /> I <br /> ES-9-2M Revised W2100 <br />
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