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72-711
Environmental Health - Public
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WATKINSON
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22055
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4200/4300 - Liquid Waste/Water Well Permits
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72-711
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Entry Properties
Last modified
3/24/2019 10:05:20 PM
Creation date
12/1/2017 12:15:40 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
72-711
STREET_NUMBER
22055
Direction
N
STREET_NAME
WATKINSON
SITE_LOCATION
22055 N WATKINSON
RECEIVED_DATE
07/10/1972
P_LOCATION
JAMES OFFIELD
Supplemental fields
FilePath
\MIGRATIONS\W\WATKINSON\22055\72-711.PDF
QuestysFileName
72-711
QuestysRecordID
1979230
QuestysRecordType
12
Tags
EHD - Public
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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ----- ------------------ --------------------- - - Permit No: 7 _ 11. <br /> (Complete in Triplicate) <br /> Date Issued <br /> ------------------------ ------------------------ This Permit Expires 1 Year From bate 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. 549 and existing Rules and Regulations: <br /> JOS ADDRESS/LOC ---------- �2 k= `'. spy- _ -------- <br /> ------------- <br /> -------- <br /> CENSUS TRACT <br /> 0�.5 d <br /> Owner's Name --------Phone ------------------------- ---------- <br /> --------- - -------- -- ------------ -------------- <br /> Address ----- -- ---------- - -G_S &'-`-'--`-""-`-�-----J--Jp4CitY -- ` ----------------------------------------- <br /> --- <br /> • , <br /> Contractor's Name --------------------- ---- ------------- -----.License # ��_ -�'_ Phone ------------------ ----------- F <br /> Installation will serve: Residence] Apartment House❑ Commercial ❑Trailer Court ❑ <br /> Motel ❑ Other --------- --------------------------------- <br /> Number of living units:___------ Number of bedrooms __ --_Garbage Grinder ------------ Lot Size _____________________-_________-.-____.-.. <br /> Water Supply: Public System and name -------------------------------------------------------------------------------------------------------------Private [ I <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam <br /> El <br /> Hardpan Adobe-❑ Fill Material ------------ If yes, type ________________________-__ y <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) �j . <br /> NEW INSTALLATION: (No septic.tank-or seepage pit permitted if public sewer is available within 200 feet,) � <br /> PACKAGE TREATMENT [ ] SEPTIC TANK'` Size_ /z _.. -- ------X-_---.---- -- Liquid Depth ---------------------.----- 0 <br /> Capacity 1_���QOType6�---_�-tet- __ Material_ =-- No. Compartments --� ...-------- a? <br /> Distance to nearest: Well -----------5--~�------------------Foundation ---- --------- Prop. Line --------5_ ____-_- <br /> LEACHING LINE X] No. of Lines -------�-________ Length of each line--------/L-,�0-_!�.--____ Total Length -------- <br /> 'D' Box ---- ------ Type Filter Material -----:.-_/?------Depth Filter Material ----- ---------------------_---- <br /> Distance to nearest: Well ------ ---------- Foundation ------.1 U..... Property Line __S�:........... <br /> _ Diameter _____'__ ��_ Number .--_--- ;Z------------- Rock Filled Yes K Ni I❑ <br /> SEEPAGE PIT [}()" Depth �'� �- <br /> r , ------------------ <br /> Water Table Depth ---------------------P---------------------Rock Size <br /> Distance to nearest: Well ------------�P4�r________________Foundation ____ _r_______ Prop. Eine _____ ....-____-- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) <br /> Septic Tank (Specify Requirements) ----------------------------------- ---------------------_----------------------------- <br /> Disposal Field (Specify Requirements) --------------------------------------------------- <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 taws, and Rules and Regulations of the San.Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following- <br /> "] certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed -=------------------------------------------ --�------------ Owner <br /> ( ` - - <br /> --- ------------- - Title ------L�_-------- �t -----`t'---- --------------------------- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY . A <br /> 1 DATE -L_b-' --------------- <br /> BUILDINGPERMIT ISSUED --------------- -- ------------------------------ ------------- ---------------------->--------------DATE ------------- ------------------ ---------- <br /> ADDITIONALCOMMENTS ---------------------------------------------------------------------------------------------- --------------------------------------------------------------- <br /> ------------------------------------------------------------ <br /> --------------------------------------------- - ------ ------------ <br /> -- ---------------------------- ------- <br /> Final Inspection by -----------------Date _ �f <br /> --- ---------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H_ 9 1-'68 Rev. 5M <br />
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