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22394
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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22394
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Entry Properties
Last modified
1/10/2019 10:03:40 PM
Creation date
12/2/2017 6:59:25 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
22394
STREET_NAME
KEYSTONE & JOAQUIN
SITE_LOCATION
30000 KASSON N/E KEYSTONE & JOAQUIN
RECEIVED_DATE
10/09/1967
P_LOCATION
DAVID GIBICH
Supplemental fields
FilePath
\MIGRATIONS\K\KASSON\30000\KEYSTONE\0\22394.PDF
QuestysFileName
22394
QuestysRecordID
1803417
QuestysRecordType
12
Tags
EHD - Public
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FOR OFFICE USE: L S� rye l aoaq cj� <br /> ------ ------------- <br /> -- -------------------------- 1 �3 <br /> APPLICATION FOI`r SANITATION PMA+IIIIIr ermit No. <br /> ------- --------------- --------- -- ------ - (Complete-in Duplicate) Date Issued .M <br />--_._-__- This Permit Expires 1 Year From Date Issued <br /> -�-----_____-- <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the woxk herein described. <br /> This application is made in compliance with County Ordinance No. 549. �yiyj <br /> JOB ADDRESS AND LOCA ION. ..Uu!l.ems" - ------ ----- - //p` ---- -- �e•r�.t -----------,�- <br /> Owner's Name__ '--- -- -----•-------------------•--, ------- - ------ ------ --- ---------- - - - --SV/------------------------ Phone------------------------••-•----•--- <br /> Address. Q ---�'Q1'�----- 5 - F <br /> �,._ <br /> Contractors Name------ --/Z_ <br /> • - -- ----------- ----------------------------- ------- ------------------------ --- ----------------- Phone--------•---•-••-----....--------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -_i____ Number of bedrooms _1---- Number of baths---t--- Lot size ---40x_�a Q -------------------- <br /> Water Supply: Public system ❑ Community systemPrivate ❑ Depth to Water Table ..00ft [� <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay dobe ❑ Hardpan ❑ , <br /> Previous Application Made: (If yes,date-------- - - . ) No New Construction: Yes 1!? No ❑ FHA/VA: Yes ❑ No Q� <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____-------Distancg�from foucn�dationI-------------Material ...[....... ..._ :�L[___-_--__._..._.I <br /> No. of compartments--------_•�. .............Size---_-- ]--�cs-Y _--_Liquid depth-__-'�- .�.---- ----.-- Capacity__.. U_9_1,1 <br /> Disposal Yield: Distance from nearest well....-......Distance from foundation_,l(1___P__-__---Distance to nearest lot line___t..-Number of lines __.___1_________________________Length of each line_. ._�'Q__-_-__-.__._...Width of trench.--Z�__... ._._.____--Type of filter material.__?a-�'.f__----Depth of filter material_._/Y--- ---------Total length__.__FrG..____-____________________Seepage Pit: Distance to nearest well-.--_-______________Distance from foundation____________--___._.Distance to nearest lot line___________ <br /> ❑ Number of pits--- ------------------Lining material---------------------. Size: Diameter-----------------------Depth.......--- -------------------- <br /> Cesspool: Distance from nearest well ................Distance from foundation---------..----- . Lining material------------------------------------- <br /> El Size: Diameter- -------- ----- ----------- --- Depth------------------- ------ --- --- -- --------------Liquid Capacity- --------------------------gals. <br /> Privy: Distance from nearest well_ ...........----------------._.............Distance from nearest building-___._-._________.___-__-----.-.-__. <br /> ❑ Distance to nearest 4ot line -------------- - - --------------------- ------- - ---- ------------------------------------------------r- -------------------------------- <br /> Remodeling and/or repairing (describe)------ --------------------------------- ------------------------------------------------------------- ---------------------------------------_�� <br /> -- ----------------------------------------•--------------------------•----- ------------------------------------------------------ +:� <br /> ----------------------- <br /> ---- -------------------------------------------------------------------- -------------------------------------------- <br /> --------------- ----•--------------------------------------- ------- ------------------------------------------------------------- <br /> ---------- ----------------------------------------------------------------- - <br /> 1 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 es nd reg ti sof a San Joaquin Local Health District. �k <br /> (Signed)_ - -- - --- ----- ---------- --------------------------- - ---------- ------ -----(Owner and/or Contractor) <br /> By:-------------------------------- ----------------------------------- ------------------------------------------------------------(Title)---------- -....----..----- --- ------ --------- <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.------ ATE--------- ---------- ----- ----- <br /> REVIEWED BY---- -------------------- -------_--------------------- ------------------------------ ----------------------------------- DATE------------- ---------------- --------- --------------- <br /> P <br /> BUILDINGPERMIT ISSUED-------- -- ------------------------------------- ---------•----------- ------------------------- DATE---------------------------------- ...._------------------- <br /> Alterationsand/or recommendations:----- ------------------ --- ---------------------------------------------------------------------------- ----------- ----------------- <br /> Date.... .ICJ`A0 6 -- -------- ------------ <br /> FINAL INSPECTIO BY:... - . - .'/-_ -- --- -- ---- --- >� - --- ---- <br /> S JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazeflon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9t1, Street <br /> Stockton,California Lodi. California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />
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