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72-829
EnvironmentalHealth
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LINCOLN
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4200/4300 - Liquid Waste/Water Well Permits
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72-829
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Entry Properties
Last modified
3/25/2019 10:06:06 PM
Creation date
12/2/2017 9:36:39 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
72-829
STREET_NUMBER
1601
STREET_NAME
LINCOLN
STREET_TYPE
RD
City
STOCKTON
SITE_LOCATION
1601 LINCOLN RD
RECEIVED_DATE
08/15/1972
P_LOCATION
HENRY SHEA
Supplemental fields
FilePath
\MIGRATIONS\L\LINCOLN\1601\72-829.PDF
QuestysRecordID
1821771
Tags
EHD - Public
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FOR OFFICE USE: '-APPLICATION FOR SANITATION PERMIT q <br /> Permit No. <br /> --------------------------------- - ---------- - (Complete in"Triplicate) <br /> p V. <br /> This Permit Expires Date Issued <br /> ----------I----- <br /> ------------------------------------------------------------------------------------ <br /> I Year From Date Issued <br /> I Application is hishppallicat onQisomade in co plias ecwi h CounttyDistrict <br /> Ordinan a Nom5A9 and existing Rulesinstall <br /> nd the <br /> Regulatio sherein <br /> described. T pp <br /> / I C, V /L-l. r --.-----CENSUS TRACT -------------------------- <br /> JOB ADDRESS/LOCATIO <br /> 'f ------ • <br /> Phone <br /> Owner's Name -------- 9,4------------------------- - - <br /> Address � --- �- w:----CT-------- -------------- - city ___---______ <br /> License # r <br /> a <br /> i <br /> Contractor's Name LoJ..,_� Phone <br /> Installation will serve: Residence [ partment House❑ Commercial :❑Trailer Court l <br /> Motel ❑ Other ----- ------- ------------------------------ <br /> i <br /> Number of living units:_._----- Number of bedrooms _47- Garbage Grinder ----�- -- Lot Size <br /> Private ❑ <br /> I Water Supply: Public System and name ---- <br /> a depth of 3 feet: Sand Sit❑ Clay E] Peat❑ Sandy Loam -[I Clay Loam <br /> Character of soil to p <br /> I Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type ---------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> _ Li ui Depth -------------------------- <br /> ( PACKAGE TREATMENT [ ] SI=PTIC TANK [ ] Size--------------------- q p <br /> I POO— --- Type ---------------- ----------- <br /> Capacity _____�----- yp ___ Mafierial___L��c/�T o. ompartments ---_--.---- <br /> Distance to nearest: Well __,_____________________________ <br /> ---._Foundation ---------------------- Prop. Line -------------•-------- <br /> No. of Lines ---------/------------- Length of each line-------- `j`IJ 6------ Total Length ------'� =� <br /> LEACHING LINE [ ] - - <br /> I I -Depth Filter Material ------I� <br /> -------------------------- <br /> 'D' Box ------------ Type Filter Material ---r�x;------- P <br /> Distance to nearest: Well ---------------- <br /> Foundation Property Line ------------------------ <br /> De th -------- Diameter --------------.. Number ------ --------------------- Rock Filled Yes ❑ No ❑ <br /> SEEPAGE PIT [ ] P ------ - <br /> WaterTable Depth ------------------------------- •------------Rock Size -------------------------------- <br /> r <br /> Distance to nearest: Well ----------------------------•- -----. Foundation -------------------- Prop. Line --- ---_-_--------•. <br /> - <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------- <br /> Date ----------------------------------) <br /> i 1 <br /> Septic Tank (Specify Requirements) ----_----------------------------------------------------------------------------------------------------------- <br /> - '�B_ t_rV -l1��" fQ ------------------ <br /> Disposal Field (Specify Requirements) -- �j f ---- - 1 ----- <br /> I , , <br /> G1`�``{ ss 'I-f1��_i c.---------0-f-----�- ) �5 �f` � `' �`�r <br /> -�---- - Y-L ---- y�.74e ------------ ) <br /> ----------�------c� -� <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be dome in accordance with San Joaquin <br /> County Ordinances, State Laws,.and Rules and Regulations of the San Joaquin local Health District. Home owner or licen- <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 become su ct to Workma pensation laws of California. <br /> Owner <br /> SignedSigned ---- -------------- <br /> BY - ` ---------- Title -------- --------------- -------- ----------- <br /> (If of er than o i finer) <br /> FOR DE ARTMENT USE ONLY <br /> r '!/f1' <br /> DATE ...... <br /> APPLICATION ACCEPTED BY, -------.- -- -__---__-__----.-- <br /> BUILDING PERMIT ISSUED ---°� :----- ---------DATE -------- <br /> ADDITIONAL CQMMENTS _ <br /> - --------- i_� <br /> - ---------------- ---------- -- ------------------ ---- - - - <br /> -- --------------------------------------------------------------------------------- <br /> ----- ------------ 5= -1------ <br /> -------------------------------------- - <br /> ------------ - ----------- ------- - ------- .. ate -----`�- -------- --•- --- <br /> Final Inspection by- ------ ------ --`'��- iL c <br /> D <br /> ------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'b8 Rev. 5M <br />
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