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74-1096
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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74-1096
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Entry Properties
Last modified
4/8/2019 10:07:50 PM
Creation date
12/2/2017 7:51:25 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
74-1096
STREET_NUMBER
10783
STREET_NAME
KIMBERLY
STREET_TYPE
DR
City
MANTECA
SITE_LOCATION
10783 KIMBERLY DR
RECEIVED_DATE
12/05/1974
P_LOCATION
RAMOS REAL ESTATE
Supplemental fields
FilePath
\MIGRATIONS\K\KIMBERLY\10783\74-1096.PDF
QuestysFileName
74-1096
QuestysRecordID
1809744
QuestysRecordType
12
Tags
EHD - Public
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II <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -16�F,6 <br /> Permit No. ---------- <br /> --------- ........------------------------- Ddte Issued ------- <br /> ----- <br /> This Permit Expires 1 Year From Date issued I <br /> A Aereby made to, he San Joaquin Local Health District for a permit to construct and install the work herein <br /> Application <br /> o. 549 and existing Rule's and Regulations. <br /> clesor is application is ade in compliance with County Ordinance N t 11) 1 <br /> J 05 ADDRE - CENSUS TRACT ----------- <br /> P/LULI-XTION jb--- 17 !W�3------ - ----- _.V------- i. <br /> C --------------I i. <br /> Q _34Owni e --- x-5,a_�_ ,4z-6-G- ---- -----------�__Phone -7n - <br /> or's Ncl� <br /> Add+ss ---------16- 1 4- -------------------- city --------------------------------.License # Phone <br /> Contractors Name <br /> serve: 7nce MApartment House <br /> Installation w,ill ser Re- Commercial f-]Trailer Court 0 <br /> Motel ❑Other - ------------------------------------------ <br /> Number of I i ing units:-----/.... Number of bedrooms ---)-/--,-Garbqge Grinder --------- Lot Size -------- ------------------------ <br /> --------- <br /> WaterSupplyi: Public System and name ---------------------------------------------------------------------------I--------------------------t--------Private)AI <br /> Character of soil to a depth of 3!feet: —Sand <br /> —Si It EClay EPeat ESandy Loam <br /> -EClay <br /> Loam <br /> � — —r -—ff— _".i _ I <br /> H-rjpanffAco�EF, IFMateria ------- y;spe - ------------ --------- E-- <br /> l <br /> (Plot <br /> plan, showing size of Id, location of system in relation to wells, buildings, etc, must be pladed on reverse aside.} <br /> ;L i I k <br /> NEWyINSTALVATION- (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> Liquid Depth 4_s---'-----'----------- ' <br /> f <br /> TREATMENT, SbTIC TANK;[ Size---------------------------------------------''_— llc.'� <br /> A <br /> 3� <br /> ��4_ Material__&4_t4XP4'No. CompartmentiT_-7-1 ............. <br /> Type <br /> Capacity - -------- <br /> Distance-to nearest: -)------------------Foundation ---- Pr6ip. Line*__ --------------- <br /> [,F I I : . (\, 77-C r% f 1. <br /> LEACHING LINE L i ms-1------------------------ Length of each line.--------------------.------ Total Lendth ------------------A-------- <br /> II <br /> --J <br /> YB&43��6_ Type Filter Material ---- ..-____Depth Filter Material _____101---------------- <br /> -r.opert ' Line ---------------1�----- <br /> Distance to nearest; <br /> kGE PIV Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ N, oSEEP, 1071 <br /> Water Table Depth -----------------------------------------------Rock Size -------------------------------- <br /> - I <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line -------------I......... <br /> '70 <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------1 <br /> 'Septic Tank (Specify Requirements) -------- --------------------------------------------------------------------------I--------------------------- ---------------------------- <br /> Disposal Field (Specify Requirements) ------------------------------------------------------------------------------ --------------------------------------------!--------- <br /> 11------------------------------------I----------------------------------------------------------------------------- ------ - ----------------------------------------------L__--- <br /> ---------- --- -- -------------- ---- ----------------------------------------------------------------------------------------------------------------------------------------I--------- <br /> (Draw existing and required addition on reverse side) <br /> I he by certify that I have prepared this application and that the work will be done in accordance with Son Joaquin <br /> ro <br /> I istrict. Home owner or licen- <br /> county Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health Di <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to I become subject,to Workman's Compensation laws of California." <br /> Signe I ---------------------------- Owner <br /> I------- -- ------ --- <br /> By _4 -----------------------------------I---- Title ---- -------------- --------------- ------------------------------------ <br /> - -- ---------- ---------- <br /> II <br /> (If other', than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --------------------------------------------------------------------------- DATE <br /> BUIL 'ING PERMIT ISSUED --- --------------------------------------------------------------------------------------------------DATE ------------------------------ <br /> ADDT, IONALj'COMAAtNTS ------------------------------------------------------------------------------------------------------------- ------------------------------------------- ---- <br /> In-----------!1;--------------------------------------------------------------------------------------------------------------------------------------------------------------------------j---•---- <br /> I----------------------------------------- -------------- <br /> ----1 <br /> --------------------------------------------------------- ---------------------------------- ----------------------------------------- -----------------------------------J-------- <br /> ------- ----------- -------- <br /> ------------------- ----- --------------------------------------- --------------------------------------------- Date___j-.-:C <br /> Final"Inspection by: ----------- - --------------------------------- -------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />
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