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68-1100
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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CHEROKEE
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14900
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4200/4300 - Liquid Waste/Water Well Permits
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68-1100
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Entry Properties
Last modified
2/5/2019 10:14:56 PM
Creation date
12/4/2017 5:21:03 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
68-1100
STREET_NUMBER
14900
Direction
N
STREET_NAME
CHEROKEE
STREET_TYPE
LN
City
LODI
SITE_LOCATION
14900 N CHEROKEE LN
RECEIVED_DATE
12/31/1968
P_LOCATION
LODI TRUCK SERVICE
Supplemental fields
FilePath
\MIGRATIONS\C\CHEROKEE\14900\68-1100.PDF
QuestysFileName
68-1100
QuestysRecordID
1687426
QuestysRecordType
12
Tags
EHD - Public
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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No. .(P�-l�b_o. <br /> ---- -- ----------- ------------------------------------- (Complete in Triplicate) <br /> --------------------------------------------------------- Date Issued --... ---=--- --- <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a per 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 /> C CID ! �s . -------- - <br /> r..------CENSUS TRACT ----------- -------------- <br /> -- ---------------- ----- � _- -----------JOB ADDRESS/LOCA TI N .--- - <br /> Owner's Name ---- <br /> - -----------------Phone ------------------------------------ <br /> Address ----- -- ll-----/� -� - City -------------------------------------------------------------• ------ <br /> Contractor's Name .lr -fir 2G ----� --------------License # Phone ------------------------------ <br /> Installation will serve: Residence ❑ Apartment House❑ Commercial []Trailer Court ;❑ <br /> Motel ❑ Other --, --- - - --- ` <br /> Number of living units:--r"'---- 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 F] Peat El Sandy Loam.fClay loam ❑ <br /> Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type -------------------------- <br /> (Plot <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 sewer is available within 200 feet,) Q <br /> PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size------------------------------------ ----------- Liquid Depth -------------------------- <br /> capacity <br /> ------------------------- <br /> Ca acitY ------------ - - Type -------------------- Material--------------------- No. Compartments --------------------_ <br /> Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ----------•----------- � <br /> LEACHING LINE [ ] No. of Lines ---------------------— Length of each line-_------------------------- Total Length ------ -------------.-.-_.-- <br /> 'D' Box ------------ Type Filter Material --------------------Depth Filter Material ----------------------------------•--------- <br /> Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line ------------------------ <br /> SEEPAGE <br /> --------- ------SEEPAGE PIT [ } Depth ----- Diameter ---------------- Number ------ Rock Filled Yes ❑ No i[] <br /> Water Table Depth --------------Rock Size --.-----_---_------------------- <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ------------------_-- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -----------------------------------11 <br /> Septic Tank (Specify Requirements) -------------------- -- - ----- ---- ------------------------------------------------------- ---------_---------------------------- <br /> ------------------ <br /> Disposal Field (Specify Requirements) ------ ------ <br /> - -- <br /> ---------- ---------- <br /> - ------ ---- - ------ <br /> ------------------- <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 ---- -------------- .............. ------- Owner <br /> ._ - — Title <br /> --------------- ------------------ <br /> ----------- - ------- ------ <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> -----------. DATE <br /> APPLICATION ACCEPTED BY --- - - -1 -- w------------ <br /> BUILDING PERMIT ISSUED --------------------------------------- <br /> -----------------------DATE -------------------------------- ---------- <br /> ADDITIONAL COMMENTS ----------------------------------- ---------------------------------------------------------------------------------------------- -------------------------- <br /> - <br /> -------------------------------------------------------------------------------------------------------------------- <br /> '-- ---------------------------------------- -------------------------------------------------- - <br /> Final Inspection by.- Date Z <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />
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