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50-68
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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KASSON
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EL DORADO
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2G014
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4200/4300 - Liquid Waste/Water Well Permits
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50-68
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Entry Properties
Last modified
1/26/2019 11:34:52 PM
Creation date
12/2/2017 6:55:41 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
50-68
PE
4211
STREET_NUMBER
2G014
STREET_NAME
EL DORADO
City
TRACY
SITE_LOCATION
30000 KASSON RD - 2G014 EL DORADO
RECEIVED_DATE
4/7/1954
P_LOCATION
DEAN SYBRANT
Supplemental fields
FilePath
\MIGRATIONS\K\KASSON\30000\EL DORADO\2G014\50-68.PDF
QuestysFileName
50-68
QuestysRecordID
1804192
QuestysRecordType
12
Tags
EHD - Public
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APPLICATION FOR SANITATION PERMIT Permit No. ...6.9... <br /> (Complete in Duplicate) <br /> Date Issued _-4..o...7: <br /> �O <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. <br /> JOB ADDRESS AN OCATION.--- .-� _ .---.- - _-�r��!•r !�� <br /> --------------------- <br /> Owner's N e---- . A -- ' Phone-------------------- <br /> - ----- --- ---- - -- --- r---- <br /> Address_. ........ •. --------------------•••---- <br /> Contractor's Name........................ ----.....--------------...---=-----------------------------------------------•-- --•- Phone................................... <br /> Installation will serve: Residence Apart t House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ . Other <br /> Number of living units: ._/___ Number of bedrooms ...l--- Number of baths _/.... Lot size ....__ <br /> Water Supply: Public system ❑ Community system, Private ❑ Depth to Water Table X ft. Q` <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay J" Adobe❑ Hardpan ❑ Nf1 <br /> Previous Application Made: Yes ❑ No Qj New Construction: Yes Jit, No ❑ `,�� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if bli sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well_s �___Distance f u a�----L_I�.______-M�}te�r' I_________ .0----- <br /> No. of compartments___________-'Y--_-- ize... " --Liquid depth---------- Capacity___ _ ?_ __--__ <br /> Disposal Field: Distance from neare ell_ . -_Distance from foundation..._. _-- Distance to nearest lot•�li e-_ ....W <br /> ($ Number of lines........ _____ ____ ength of each line.. �._ 1�W Width of trench____ -- _ _______--------- O <br /> ` Type of filter material..._. }"�' ^91 epth of filter material------- _ -----Total length.........S4------------------------ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line---_------------- d <br /> ❑ Number of pits----------------------Lining material----------------------Size: Diameter-------------- --------Depth-------.......................... 4 <br /> Cesspool: Distance from nearest well-----------------Distance from foundation.----.--------------Lining material------------._______________--__-_---. <br /> ❑ Size: Diameter.-------------------------------------Depth------ --._..... -•------•-•------ --- Liquid;.Capacity............................gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----------------------------------........ <br /> ❑ Distance to nearest lot line-----------------------------------------------------------------------------------•--------------------•-------•---------------------------- <br /> Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------------------------- --------------------------------- <br /> ------------------•---------------------,-------------------------------------------------------------------------------------------------•----•------•-•-•--------------------------------4--------------------------------- <br /> -----------------•------------------------------- ---•------•---•---•-------------••--•-------------••------••---•---•-•----•--•-•------------------------------------------------------------- --------••----•------- �r <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-------------•---------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> Jnr., <br /> (Signed).... p ._ ________(Owner and/or Contractor) <br /> ---------------------------- ------- ------------------ <br /> r t•► .. •-- -- ----------••----•-----------....--••--••-••-....... ..............(Title)-------------------------------------------------------------- <br /> By: <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------------------------------------- ------- -- --•--- • -----•-•----•-----•-----•--- DATE----------------- 1 <br /> REVIEWEDBY-------------------------------------------------------- --- ------ -------------------------------- DATE-------k. -- •----------•--------------•-•------ <br /> y <br /> BUILDING PERMIT ISSUED.............-------------------------- ----- --- ----------------------------------------- DATE--------- .............. <br /> •.......................... <br /> Alterationsand/or recommendations:............... ------------------------------------------------------------------------------------•------------------------...----------------•------------ <br /> -----------------------------------------------------------------------------------------------------------•------------------------------------------------------------------------------------------------••---------•--- <br /> - ----------- ----- --- ---------- ----------------------------------------------- - <br /> JFINAL INSPECTION BY:-------------- ------ Datel. ------------------------- <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 10-52 Revised W-2100 <br />
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