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18738
EnvironmentalHealth
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KRELL
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4200/4300 - Liquid Waste/Water Well Permits
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18738
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Entry Properties
Last modified
12/22/2018 10:11:12 PM
Creation date
12/2/2017 8:11:52 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
18738
STREET_NUMBER
1535
STREET_NAME
KRELL
City
FRENCH CAMP
SITE_LOCATION
1536 KRELL
RECEIVED_DATE
03/30/165
P_LOCATION
P RODRIGUEZ
Supplemental fields
FilePath
\MIGRATIONS\K\KRELL\1535\18738.PDF
QuestysFileName
18738
QuestysRecordID
1812068
QuestysRecordType
12
Tags
EHD - Public
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/FR OFFICE USE: <br /> �--------/y : -" APPLICATION POR SANITATION PERMIT Permit No. ..f_ •!..- - <br /> --------------------------------------------------------- /(Complete in Duplicate) Date Issued _�J�d - <br /> .� --.,--- -"--_.... _-_ This Permit Exl2ires 1 Year From 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. <br /> ----------------... S <br /> . �. <br /> JOB ADDRESS AND LOCATION----_ <br /> � Phone--------------------------- <br /> � r '_�. v.�_z " <br /> Owner's Name---------------•----------------------f-- '------ ------- .G - - -------- <br /> --•-----------•---•----•---- ---------------------- <br /> Address----------------------------------------../� ---- - - <br /> Contractor's Name r f - � Phone-46-6----V1 <br /> Installation will serve: Residence ©partment House ❑ Commercial E] Trailer Court ❑ Motel E] Other ❑f <br /> Number of living units: _-I-- Number of bedrooms _ _ Number of baths --1--- Lot size ---------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private [t}---Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Ug-r--lay Loam [] Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No 0-- New Construction: Yes ®-IN-o ❑ FHA/VA: Yes ❑ No Ea' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f <br /> Septic T nk: Distance from nearest well.-- ---.._-Distance from foundation C _-_----.Material-.-- -�j-------�/ <br /> No. of compartments.--- ----------------Size__G� `-- f'/C-------Liquid depth---, --! . . _'_------Capacity_/, �------ <br /> L!r <br /> Disposal field: Distance from nearest weil._��.....Distance from foundation_.-�� <br /> ........Distance to nearest lot line_-�_-_---" <br /> Length of each line-_"----?4=:.1*-----------Width of trench------ .- ------------- <br /> ER Type <br /> of lines----___-.. "� <br /> Type of filter material.. -,f5 --Depth of filter material-"`k-_---------_..Total length_----"-_--- (a----------------- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line__--_---..._..__ <br /> ❑ Number of pits----------------------Lining material-------------- ----- - Size: Diameter-- --------------- ----Depth------------------------------- W. <br /> Cesspool: Distance from nearest well-----------------Distance from foundation.-------------------Lining material -.._---.-----..---.--."------------- <br /> ❑ Size: Diameter--------r---------------------------- Depth------- --------------------------------- ----------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well--------------------______.________--.---------Distance from nearest building-.-_---_-..__--_._.---.-__--..--___-_----_ 17 <br /> ❑ Distance to nearest lot line------.-------------------------------------------------------------------------------------------------------------------------------------- N <br /> Remodeling and/or repairing (describe): ;, C----CLQ ���= -rte � � "------------------- -------------------------------------- Z <br /> ----------------------- <br /> - - - -- - - -- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County a <br /> ordinances, State d rules and regulations of the San Joaquin Local Health District. <br /> (Signed)----------------- ----- - -�-- - �Qwneand/or Contractor <br /> - - <br /> ---•- ?� a.-E--�c.-�-------------------------------------------------------- Title --- <br /> (Plot plan, showing size of lot, location o system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY..-- - -----------------I---------------------------------------- DATE-_3-------3.0-- <br /> - -3.0-+4?4-------------------------- <br /> REVIEWEDBY----- ---------------------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED-----------------•---------------- --- ----------------------------- DATE-------------- --------------------------------------------- <br /> Alterations and/or recommen ations:______.._. ----- ---------- ------------ --------------- --------------- <br /> ------------------------------------------------------------------ <br /> -- --------- <br /> --- ------------------------------------------ -- <br /> --------- --- -- --- - -------- ------- --------------- <br /> - <br /> C--------/ <br /> �`�� ---------------------------------------- <br /> FINAL INSPECTION BY-------- ------'- -• :--- ✓! <br /> Date..- ---`- - <br /> ---- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1401 E.Hotellon Ave, 300 West Oak Street 124 Sycamore Street 205 West 4th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.CG• <br />
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