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18726
Environmental Health - Public
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4200/4300 - Liquid Waste/Water Well Permits
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18726
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Entry Properties
Last modified
12/22/2018 10:07:53 PM
Creation date
12/1/2017 6:25:43 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
18726
STREET_NUMBER
0
STREET_NAME
RAY
STREET_TYPE
RD
RECEIVED_DATE
3/24/1965
P_LOCATION
FRED J NIPKAU
Supplemental fields
FilePath
\MIGRATIONS\R\RAY\0\18726.PDF
QuestysFileName
18726
QuestysRecordID
1905073
QuestysRecordType
12
Tags
EHD - Public
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FOR OFFICE USE: r� <br /> --- - -- - --- ------------- APPLICATION FOR SANITATION PERMIT '' l l -�. <br /> Permit No. <br /> - <br /> ---------------- --------- ------- - ----------------- (Complete in Duplicate) Date Issued ._ _.S <br /> This Permit Expires 1 Year From Date Issued <br /> ------------ <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 compliaFV <br /> with County Ordinance No. 549. <br /> '' <br /> JOB ADDRESS D� LOCATION- tp� <br /> �`°T° �"""`d'`- -----`-�`- <br /> Owner's Name__Y�Y�-'r_'±�---- -•------ ----------------------- -------------------- -------- -------- Phone.----•------•--------•-------------- <br /> Address_..._ <br /> - - <br /> ----- - -------- <br /> ------------------------------------------------ <br /> - - - - <br /> r f <br /> Contractor's Name h.L - ..... C/T- --- Phone <br /> Installation will serve: Residence M<Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _1____ Number of bedrooms _J_ Number of baths __I___ Lot size ------ ________________________ <br /> Wafer Supply: Public system ❑ Community system [I Private eDepth to Water Table r___-_-_- ft. <br /> Character of soil to a depth of 3 feet: Sand [-] Gravel E] Sandy Loam Clay Loam E3Clay ❑ 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 /> Se nk: Distance fom nearest well__._S__0f__ _ Distan <br /> a from foundat_on_ __o�R-._.____ _ ________________________ <br /> No. of compartments----- ---------- Sizeb--X-5r-X.XLiquid depth----!�---------------- Capaa#y_.I_4;?_¢< 4E <br /> � <br /> Dispo Field: Distance from nearest wellA)---------Distance from foundation____l�---------Distance to nearest lot liine�___-___-_-- <br /> P�/]/ Number of lines___.____f____..._ Length of each line---1_06- __�}____.__.Width of trench-. --------------------- <br /> Type of filter material.___._r _____Depth of filter material____ - length----(_0_Q____________________________ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line._-_________--_ <br /> ❑ Number of pits----------------------Lining material----------------------Size: Diameter-----------------------Depth---.----------------------------- <br /> Cesspool: Distance from nearest well_________________Distance from foundation------------.------ Lining material------------------------------------- <br /> ElSize: Diameter--------------------------------------Depth----•-----------------------------------------------Liquid Capacity-.--------------------------gals. <br /> Distance from nearest building <br /> .Privy: Distance from nearest well--------------- --------------------------------- 9 <br /> ❑ Distance to nearest lot line------------------------------------------------- --------------------- -------------------------------------------------• ---- ---------- <br /> Remodelingand/or repair' ribe)----------it---------------------- ------ ---------------------------------------------------------------------•------------------------------------- <br /> ------------------------------------- --------------- ---- ------------------------------ -------------------------------------------•----------------------------------------------- <br /> I hereby certify I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State ws, a d rules and regulations of the aquin Local Health District. <br /> (Signed)----------- ------ --- --•--------------- - --�------- <br /> ---- ------ -------- ........ --- ------------------------------------ - or and/or Contractor) <br /> 8 Ti+le}------------------- --------- ---- ---- ----- - -------------- <br /> -- --------- ---- ------ ----------- ------------ --- - <br /> (Plot plan, showin ze of lot, lova+ion of system in relation wells, buildings, c., can be placed on reverse side}. <br /> FOR DEPARTMENT USE: ONLY <br /> APPLICATION ACCEPTED BY_.--.-. -- F --- DATE-----3-71- - ------------------------------------ <br /> REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED-------------------------------------------------------------•------------------- ------------------ DATE------------------------------------------------------------- <br /> Alterationsand/or recommendations------- --- ----------------------------------- ------------•--------------•--1------------------•--------------•--------------- -•--------------------------- <br /> --------------------------•--------------------------------------------------------------------------------- ---------•------ ----------------------------------------------------------------------------------------------- <br /> ----------------- -----------------------------------------------------------------------------------•--------------•-•------------------------------ ---------------------------------------------------------- --------- <br /> ---------------------------- - ---------------•--------•---•------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------- - - - ----------------------- ----------------------------------------•----•----------------•--------- -•------------------- ---------------------------------------------------•-- <br /> FINAL INSPECTION ------------------------------ Date-----J- ------•--------- <br /> ------------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ha:*llon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stocklon,California Lodi,California Manteca,California Tracy,California <br /> ES 9 RE;VISED B-59 3M 3-'63 i.P.q O. <br />
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