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18741
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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18741
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Entry Properties
Last modified
12/22/2018 10:11:31 PM
Creation date
12/3/2017 2:31:04 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
18741
STREET_NUMBER
3420
STREET_NAME
MICHIGAN
City
STOCKTON
SITE_LOCATION
3420 MICHIGAN
RECEIVED_DATE
3/30/1965
P_LOCATION
J MERLIN RUNDQUIST
Supplemental fields
FilePath
\MIGRATIONS\M\MICHIGAN\3420\18741.PDF
QuestysFileName
18741
QuestysRecordID
1851651
QuestysRecordType
12
Tags
EHD - Public
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�74 <br /> OE USF <br /> 7 l <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------ - -------- --------------- (Complete in Duplicate) <br /> .----.- This Permit Expires i Year From Date Issued bate Issued _____ <br /> Application is hereby made to the San Joaquin Local Healfh 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--___,-_ f_-. ()----- -------------------------------•-•----•--------- ----------•--------------------------------- <br /> Owner's Name------ ----- �a' �-------- �tctit ��--------------------------------------------------------------- Phone (c zr � _�3 <br /> Address S ---------•--•------- <br /> -.--• l/t -K---------------- <br /> Contractor's Name------0��__I/1_Z..1�------------------------------------------------------ - ----------•-------- Phane----- --•--'•'--- - <br /> Installation will serve: Residence'4 Apartment House ❑ Commercial [] Trailer Court ❑ Motel ❑ ,/Other ❑ <br /> Number of living units: -------- Number of bedrooms . ._ Number of baths l-,& Lot size ---/1-6---X___764------------------------------- <br /> Water Supply: Public system [$ Community system ❑ Private ❑ Depth to Water Table --4- ft. <br /> �19- <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® Hardpan ❑ <br /> Previous Application Made: {If yes,date-----------_--------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <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)ji*,_f------Distance from foundation----L ------------Ma fe.ial__...� .- ` �'___ _______________ <br /> No. of compartments------�--------------Size-- X__�Q___X-----------Liquid depth.-- -f�-./-----..Capacity-��_�l__�fl� <br /> disposal Field: Distance from nearest well-`71eAi._._Distance from foundation---/,/)------------Distance to nearest lot line-__ <br /> Number of lines----_--�_________________----Length of each kine_/C.j_--gt'.�/ _____.-Width of french--- <br /> of filter material--S<---tP�_.Depth of filter material___._./� __Total length-------lea_______________________-- <br /> Seeps e-Fit:- Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line__._--.___._----- r <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-_---- ------------Depth---------------------------------, I <br /> Cesspool: Distance from nearest well-----------------Distance from foundation------------ Lining material---------------------------.--------- <br /> [�" <br /> /f] Size: Diameter------ -------------------------- ----Depth--------------------------------- ---- -------------Liquid Capacity- - ------------------------gals. <br /> /Priivvy:' Distance from nearest well-------------------------------------------------Distance from nearest building--------------._----.-.-------_____------ <br /> ❑ Distance to nearest lot line---------------------------------- --------------------------------------------------------------------------------------------- . <br /> --�-------`-'-- <br /> Remodeling and/or repairing (describe):------- - ...... e -- «!- ------•------••- p!, <br /> --------------------------------------------------------------------------------------------- --------------------------------------------------------------- ----------------------------------- -------- o <br /> fl <br /> ----------------------------------------------------------------------------•----•--------------------------------------------------------------------------------------------- -- -- 3 <br /> -----------------------------------------ff------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I hada prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> ---------------- - ----- --- ---------------------- ------------- - ------------------------------- Owner and/or Contractor <br /> [Signed}-------�owingg <br /> --------- ---------- - - ( / <br /> � a � <br /> By�-- --------------------- -------------------------- -----------------(Title).------------------ -------- ---- ------- ---- --------- <br /> (Plot plan, e of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY... -------- ----------------------------- ---------------------------------------- DATE �� 5 ----------------- <br /> REVIEWEDBY--------------------------------------------- ---------- ------------- ------------ ------------------------------------------ DATE------------------------------------------------------------ <br /> BUI LDI NG PERMIT ISSUED---------------------- ------------------ ------------------------------------------ DATE------------------------------------------------------------- <br /> 0 �` F <br /> Alterations and/or recommendations: - -- -- <br /> �------�v--------- <br /> ------------- <br /> rt r � `��� J�pP'�'�' " -_�� . <br /> ---------------------------------------------------------------------------------------- ------------------------------------------------------------------------------ ---------------------------------------------------- <br /> ---------------------------- ---- ---------- -------------------------------- -- -------- -------------- ----------------------------•------- ----------------------------- - ------ --- ------------------ <br /> FINAL INSPECTION BY:. j ' _-_1'4'1_'0 <br /> -------------- Date-..,'-' .-------� 5- --------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.CO. ~ <br /> 1 <br />
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