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4200/4300 - Liquid Waste/Water Well Permits
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695
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Entry Properties
Last modified
2/13/2019 10:44:48 PM
Creation date
12/4/2017 4:48:43 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
695
STREET_NUMBER
225
Direction
S
STREET_NAME
CARROLL
STREET_TYPE
AVE
SITE_LOCATION
225 S CARROLL AVE
RECEIVED_DATE
6/20/1951
P_LOCATION
JAMES V CASH
Supplemental fields
FilePath
\MIGRATIONS\C\CARROLL\225\695.PDF
QuestysFileName
695
QuestysRecordID
1681153
QuestysRecordType
12
Tags
EHD - Public
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APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <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 compliance <br /> ee}}with Count Ordinance o. 5t9. <br /> JOB ADDRESS AND LOCATION Z__ --- ----- -- --------- --------- ----------------------•---------------- <br /> Owner's Name_--___- � } _-_-_ Phone_____®-- ----- <br /> Address------ «. <br /> -- --------- ---------------------------------------------------------------------------------------------------------- <br /> Contractor's Name ----- --- <br /> _L-- -------- - Phone <br /> Installation will serve: Residence V Ap rfm House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> [Number of living units: umber of bedrooms A Number of baths UO Lot size___8�___?..-��_�__________________________ <br /> Water Supply: Public system Community system ❑ Private ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feel] <br /> Septic ank: Distance from nearest well "________Distance from f undation____�__ __ �r__.Materi I____________ <br /> 1r xax <br /> No. of compartmeats----•------- ---------Capacity___ _ ---__Size_ --(t---------- Liquid depth------ --_-------- <br /> Cesspool: Distance from nearest well_________________Distance from foundation-------------------- material-------------------------------------- <br /> 0 Size: Diameter........--------------------------•-Depth---------------------------------------------------- I <br /> Privy: Distance from nearest well---------___-------------------------------------Distance from nearest building---------I______________________________- <br /> ❑ Distance to nearest lot line------------------------------------------------ 1� <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation----_!__'____.Distance to nearest lot line_-Ia'_►_------- <br /> w <br /> ❑ Nu' ber of pits----------------------Lining material_--------_-------------Size: Diameter----..:.-it.--------------Depth'---_---------------------------- <br /> Dispas l Field: Distance from nearest well-�� ' Distance from foundation / 0 _ Distance to nearest I line------- _____ <br /> Nu tuber of lines----------- ___�iJ____________Length of each line--------------- <br /> It of trench_#____ __:____________.-____._ <br /> Type of filter materia . __ _` epth of filter <br /> .. material___-_______________ <br /> Remodeling and/or.repairing describ - , - kfl <br /> if --------- <br /> -------------------------- <br /> v - --------------------------------------------------------------------------------------- ---- ------------------------ <br /> ----------- <br /> ----- ... <br /> ---------------------------------------------------------------------:----------- ----------------------------------- --- <br /> x 5.. <br /> ..- - ��------ <br /> I hereby certify that.I have prepared this applicationkand that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws,;and rules and regulations ofihe.S-an(Joaquin Local Health District. <br /> �J� :Si ned. ` �' �--- -- - ----------------------------(Owner and/or Contractor) <br /> • 9 r <br /> Y---------------------------------------------------------------------------. -; -------------------------------------------------(Title) =--------------------------------- t <br /> (Plot plans, sho#ing size of lot, location of system in relation to well's;buildings, et .,-Au3t be filed with this applk ation). <br /> FOR DE ARTMENT USE ONLY <br /> APPLICATION)ACCEPTED,BY +` _-__•_, 1 ., ------------------------------- DATE } ------------------------ <br /> REVIEWED BY ` ---------- ".DATE_. ------------ <br /> BUILDING PERMIT ISSUED!-------------------------------t�---"-.'...---- -+----- -- -------------------------------------)-(DATE--------------------------I-------- <br /> y Alterations and/or recommendations----------------} --------- "- -- --------- ------------- ------------------- -•---------------•---------------- - <br /> _7 7 !_ ..x.¢ _ll, , .—_.,-r __ , it <br /> ---------------------------------------------------------------- ---------------------------------- <br /> ------------- <br /> -------------------------------------- <br /> ---------------------------------------------------------------•-•----------__.--------------- <br /> ----------•--------------t---- ---------------------------------=� --------------------------------------------------------- i---------------------------------- <br /> - --: = __ -- _ _ <br /> =' -- - - <br /> PERMIT No[F--_ J__--__-- ISSUED-------_-- --3 -----(Date) FINAL INSPECTION BY--------------v _ --�------:----------------------------- <br /> Date--------------------- --------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W-1639 <br />
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