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4200/4300 - Liquid Waste/Water Well Permits
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333
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Last modified
1/17/2019 10:13:26 PM
Creation date
12/2/2017 10:34:32 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
333
STREET_NAME
LONGVIEW
STREET_TYPE
AVE
SITE_LOCATION
LONGVIEW AVE LOT 97 TRACT 102
RECEIVED_DATE
02/24/1951
P_LOCATION
E B HLDEBRAND
Supplemental fields
FilePath
\MIGRATIONS\L\LONGVIEW\0\333.PDF
QuestysFileName
333
QuestysRecordID
1828173
QuestysRecordType
12
Tags
EHD - Public
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• 'I�1 �� APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> Applicafion 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 AND LOCATION__. _ _ e_cw ------kotl714t _I_�,1----------------------- <br /> Owner's Name----------------�,_B----- t_7 _Y1� ----------------------- <br /> -------------- --------------------------------------------- Phone--------------•----------- <br /> + <br /> Address-------------------- <br /> ------------ >! <br /> ------------•--------------------------- <br /> Contractor's Name_________________ <br /> ---- ---- --------------- - - Phone <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court [❑ Motel ❑ Other ❑ <br />` Number of living units: ❑ Number of bedrooms ® Number of baths L� Lot size--------------1S-�X �6 ,--- <br /> Water Supply: Public system D Community system X Private F] <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan <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____'-'r_____-Distance from foundation-------/__0--__--Material______-_____ _C _-_-_ <br /> No. of compartments__.--------% ---------- Capacity----4t_CU-------Size----}A_ 4--y_-G------Liquid depth-------- <br /> -- <br /> Cesspool: Distance from nearest well_________________Distance from foundation------------------- Lining material-------.-------.------ -------------- <br /> ❑ Size: Diameter--------------------------------------Depth---------------------- <br /> ----------------------------- <br /> Privy: Distance from nearest well____________________________________________ __Distance from nearest building <br /> ❑ Distance to nearest lot line--------------- <br /> `Seepage Pit: Distance to nearest well____________ _____ _Distance from foundation------------------- <br /> Distance to nearest lot fine:_____. --_ <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter <br /> Disposal Field: Distance from nearest well------- -____.Distance from foundation_-__./A-':?-__-Distance to nearest lot line___-- <br /> Number of lines_______________13.1.r_____________Length of each line__ Y <br /> !_< _4Q-OWidth of french--------`2_y <br /> Type of filter me. Depth Depth of filter material______-1$___`_.____,_-_ <br /> Remodeling and/or repairing (describe):-------------------------- J <br /> Ale-W-_--------11 1 7 � �t---------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 7 <br /> ordinances, State la s, and rules and regula ions of the San Joaquin Local Health District. <br /> - <br /> (Signed)__ --------------------(Owner and/oqonfffPa-r`- <br /> $Y: -------------- ---------- - Tale <br /> ( )------------------------------------------------- <br /> {Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------------------------------ C DATE------------- - <br /> REVIEWED BY---------- `'�`'� �S"} <br /> ------------------------------------------ <br /> ------------------------------------------------------------- <br /> ----------- DATE <br /> BUILDING PERMIT ISSUED_______________________ <br /> - --------------•---------------------- -------------------------- <br /> -- -----------. DATE----------------------------- ----- <br /> -Alterations and/or recommendations:_____________________ <br /> __________________________________________________________ <br /> _______________________________________________________________________________ <br /> PERMIT No-71,7-b-75-------- ISSUED---- -----7- _.-- -I----------(Date) FINAL INSPECTION BY:_-_________ <br /> Date _ ��-------------------------- k <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 1 <br /> • Stockton, California <br /> ES-9-2M 4-50 W=1639 � � <br />
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