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15105
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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15105
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Entry Properties
Last modified
11/28/2018 2:05:30 AM
Creation date
12/3/2017 1:27:37 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
15105
STREET_NUMBER
4927
STREET_NAME
MARSH
STREET_TYPE
ST
City
STOCKTON
APN
15913008
SITE_LOCATION
4927 MARSH ST
RECEIVED_DATE
12/04/1962
P_LOCATION
JAMES GAINES
Supplemental fields
FilePath
\MIGRATIONS\M\MARSH\4927\15105.PDF
QuestysFileName
15105
QuestysRecordID
1845691
QuestysRecordType
12
Tags
EHD - Public
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FOR OFFICE USE: + <br /> .. <br /> ----------y__ _ <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ... _5 <br /> ... <br /> /� <br /> -------------- h:� 1.----------- :- (Complete in Duplicate) Date�lssued /zI <br />-_..--_______________----.__..___._----------------.--- This Permit Expires 1 Year From Date Issued II ¢¢ Tr <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct aht .4 all fhe owo�fie' rein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION__.-----, - <br /> • �----ate?----- ----•- --�'4---••-•---- <br /> Owner's Name------- -- . . --• Phone------------------------------------ I <br /> Address-- -- - -�---+-- -----...........----•--------- -- <br /> --••. ----------------------------- ----------------------••••----•-•- <br /> Contractor's Name.__ __ A 'S._ '`'-`` <br /> Installation will serve: .Residence [Apartment House ❑ Commercial ❑ Trailer Court '[I Motel ❑ Other ❑ <br /> Number of living units:'.':-` <br /> ..�:_ Number of bedrooms -— Number of baths ---1__. Lot size --- ----------••-----•--•- <br /> Water Supply: Public system Community system ❑- Private E]- Depth To Water Table .------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑. Gravel 0-'-Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe�Hardpan❑ <br /> Previous Application Made:-(If yes;•date--------------------) No'B"_'�New Construction: Yes [B"No ❑ FHA/VA: Yes ❑ No E�' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic T nk: Distance from nearest. well��_-_---Distance from foundation__lii.._.___.___ iv�aterial___(__________------------- <br /> 4 <br /> ____________ <br /> No. of coin artments_._�------------------Size__3 4. _ Li uid de tH -----------------------Ca aci <br /> D <br /> w. p9 P. P tY <br /> Disposal Field: Distance from nearest well__--___Distance from foundation/Q_i--------------Distance to nearest lot line__l55........... <br /> Number of lines-----1----------------------------Length of each line----15,0-----------------Width of trench..... t'----------_-..------ , <br /> Type of filter material__�]kC._�--------Depth of filter material_.1,t_"f------------Total length----9d__ ___________________________ -� <br /> Seepage Pit: Distance to nearest well___ ----------Distance from foundation_16______________.Distance to nearest lot line... <br /> a/ Number of pits-------I-------------Lining material__ AC-k------Size: Diameter__-_.33__`.'__..-_.Depth___.2_S_.___-__--.......... v T <br /> 'Cesspool: Distance.from nearest well-----_---------Distance from foundation--------------------Lining material-----------------------------------___. i <br /> ❑ Size: Diameter-------------------------------------Depth-------------- -------------------------------------Liquid Capacity----------------------------gals. Q l <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-____.-_______.___-.----_--___-_____._- <br /> ❑ Distance to nearest lot line------------------------------------------------------------------------ ---------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):--------------: •- <br /> --------------------------------------•-------...--------------------------------------------------------- ------------------•--------- <br /> ---------------------------------------•-•--•- -------------------•--------•---------.....__....----•------------------------------------------•---------_-__ --------------•---._.._.--.-- --------- <br /> ----------- <br /> - <br /> __v--•------------------------•------•------- ----------------- ------------------------------------ ..-•-------------------------------------- --------------_----------------- <br /> ----------- <br /> ------------------------------------ <br /> ---------- _ <br /> ---------•------------------------- -----`-------------------------------- ------ ---•--------------------------------------------------- -=---------------------------•----------.---- ----------- <br /> m <br /> I hereby certify that l have prepared h' a lica+ion nd that the work will be done in accordance with Sen Joaquin County ! <br /> ordinances, State laws, and rules and reg ion of the n Joaquin Local Health District. y l <br /> �I <br /> -- ---------- -------------------------------------- ------------------- ----- Owner and/or Contractor <br /> (Signed)..... ............... ( / ) <br /> .- ---(Title)-- <br /> By:._ oo <br /> (Plat plan, showing size of lot, ton of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> �i <br /> FOR DEPARTMENT USE ONLY <br /> 1A <br /> APPLICA710N ACCEPTED BY-_k_,.)-�------ ------ ---- ---- --------------------------------------------I---- DATE---l;� ,�- &--�---------- 1 <br /> REVIEWED BY---------------------------- ----- --------------------------------------------------------- --- DATE------'•------•---•--------------------- <br /> --- - -------------------• -------------•-- <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE-----.------------------------------------------------------- <br /> Alterations and/or recommendations:______________ -------------------------------------------- - l <br /> ..................... <br /> �tp <br /> ---- ._ -------- --------- ------- . <br /> k. -------------------------------------------------- ------------------- <br /> 1=lNAL INSPECTION BY: `` � `�- =- Date f -1= ...... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT ` <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8.59 2M 5-62'ATLA5Tr <br /> f <br />
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