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SU0006563 SSNL
Environmental Health - Public
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SU0006563 SSNL
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Entry Properties
Last modified
5/7/2020 11:32:32 AM
Creation date
9/9/2019 10:14:25 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
FileName_PostFix
SSNL
RECORD_ID
SU0006563
PE
2622
FACILITY_NAME
PA-0700221
STREET_NUMBER
800
Direction
N
STREET_NAME
SHAW
STREET_TYPE
RD
City
STOCKTON
APN
14327038
ENTERED_DATE
5/15/2007 12:00:00 AM
SITE_LOCATION
800 N SHAW RD
RECEIVED_DATE
5/15/2007 12:00:00 AM
P_LOCATION
99
P_DISTRICT
002
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\S\SHAW\800\PA-0700221\SU0006563\SS STDY.PDF
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EHD - Public
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FOR OFFICE USE: <br /> --- APPLICATION FOR SANITATION PERMIT •J <br /> ............. ......._ . - Permit No. .. �-•-------- <br /> (Complete in Triplicate) . - -- <br /> _....................................11....... This Permit Expires 1 Year From Date Issued <br /> Date Issued <br /> ` Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No, 544 and existing Rules and Regulations: <br /> _ JOB ADDRESS/LOCATION <br /> _ .. .�� S`ALt._X/�C NSUS TRACT ....... -. . <br /> Owner's Name . --....Qii � »v. ......Phone `I��.�.-�.Z�_s .......-- <br /> Address ... ......./-.l.p- ------ .....................- - ------ .......... _........ City - ---- - --- -• -- <br /> ---•-- •-----..-..------••--•--..------- <br /> Contractor's Name .............. ... .. '- ,._? -_-,.License #z �f. S��-_ Phone <br /> Installation will serve: Residence ❑Apartment use-E] Commercial ❑Trailer Court 0 <br /> �� <br /> Motel ❑ Other ........ .... .. . ... ..___0� <br /> Number of living units:... ------ Number of bedrooms ............Garbage Grinder - -----... Lot Size ._--•-••-•• -----......... <br /> Water Supply: Public System and name ......................•----------•-•.•--- ---...-....------- -------• ---------- .................... ......Private <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> 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 sewerisavailable within 200 feet,) <br /> PACKAGE TREATMENT [ ) SEPTIC TANK Sze.- Liquid Depth _..S1--•------------v+ <br /> Capacity .f ....... Type . ......... ........ Material..... No. Compartments ..._.Z'....._..__. <br /> Distance to nearest: Well -----._JKO.-_f...............Foundation --f ___.-. Prop. Line _S_.__.. ....... <br /> LEACHING LINE �j No. of Lines -------/...._-.._... Length of/�ach� line.--------4_U,. ....... Total Length ....._ ........... S <br /> / D' Box .... ._ Type Filter Material ..!.....Depth Filter Material ._.._1_J..��.......................... <br /> Distance to nearest: Well ------ Foundation .._ .... Property Line .. ....... <br /> SEEPAGE PIT 1K Depth . i. . _. . Diameter -33 Number .-------/_.. -------------- Rock Filled Yes�] No [j <br /> r, <br /> Water Table Depth ............................ ..._-_.Rock Size /1 ��..�-s ....... <br /> Distance to nearest: Well .....j.CO.........................Foundation ---1.©._.:y`.... Prop. Line -S................ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ...............................•............ Date .................................. <br /> SepticTank (Specify Requirements) ................. .........................•-•-•--••---•------•-•--•---.....................•............._......--------....-•----------. <br /> DisposalField (Specify Requirements) ...........................•.........--••-------•--•--•-----•-•--•--••-------•-••----•---•----...-•-------.•.. _----•-•------- <br /> - --------- --------------------------- - --------- ... ...----------•-........••--------._..•••---•••••..........••-•-----•-__....••••--.._..••-•---•---•--•--•••--...._.....---...--•.....----- <br /> . .... - ---------------------------------....-------------------------------------................................................----------------------------.-------------- <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 done 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 subject to Workman's Compensation laws of California." <br /> Signed ---- ----- -joth �t <br /> _... Owner <br /> •--------_... Title _........... ' <br /> ( n owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ./�...,._ . DATE .. ..._._l.... ......................... <br /> - BUILDING PERMIT ISSUED ................... DATE ..........._.............. <br /> .... .. <br /> ADD TIAL CO TS ......._ ......... . ...... <br /> t................. <br /> _ _ - �-:--:---_::�:---- I-.-.- <br /> •- <br /> ......-• •--•-•--•-•-••-• r / <br /> 1 - .. 2 <br /> ....... �S _ �f�/ L� ?Ci �LYt:t, - ?"c4 - %LGA JKlly <br /> � :- <br /> Final Inspection 6y: . '��`.>? f` ........ Dat '.---- " <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 13 24 t.'hff Rev SM <br /> /79 1 K <br />
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