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69-394
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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88 (STATE ROUTE 88)
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18020
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4200/4300 - Liquid Waste/Water Well Permits
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69-394
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Entry Properties
Last modified
11/20/2024 9:22:12 AM
Creation date
12/4/2017 11:14:50 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
69-394
STREET_NUMBER
18020
Direction
N
STREET_NAME
STATE ROUTE 88
City
LODI
SITE_LOCATION
18020 N HWY 88
RECEIVED_DATE
5/15/1969
P_LOCATION
R S GUIDI
Supplemental fields
FilePath
\MIGRATIONS\E\88 (HWY 88)\18020\69-394.PDF
QuestysFileName
69-394
QuestysRecordID
1735312
QuestysRecordType
12
Tags
EHD - Public
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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ---------------------------------- <br /> (Complete in Triplicate) Permit No. -,/I <br /> This Permit Expires 1 Year From Date issued Date Issued -� -� <br /> --------------------------- y <br /> _ __ _________ ____ _____ <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 compliange with Founty Ordinance No. 5 nd existing Rules and Regulations: <br /> JOB ADDRESS/LOC N ._ yo-- --q- Al---- ------- --0-Y-F9 -------- - - -- -CENSUS TRACT ----------------------_- <br /> Owner's Name t � :----------------- -------Phone ------------------------------------ <br /> VV <br /> Address � Q � Y City -�/�J --------------------------------------------- ------ <br /> Contractor's Name ---- .License # _/Zy-j.F�hone ----------•--------------- <br /> Installation will serve: Residence P-Vpartment House❑ Commercial :❑Trailer Court i[] <br /> Motel ❑ Other -------------------------------------------- <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❑ ilt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam '[] <br /> Hardpan e 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 sewer-is available within 200 feet,) \ <br /> PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size------------------------------------------ Liquid Depth -------------------------- o� <br /> Capacity -------------------- Type -------------------- Material---------------------- No. Compartments -----------------:---- �6 <br /> Distance to nearest: Well ----------------------------- <br /> ____-_- ------------ ------Foundation -------- ------- Prop. Line ---------------._-_ -- <br /> LEACHING LINE [ ] No. of Lines ------------------------ Length of each Jine---------------------------- Total Length -----------._--_---__._._._- <br /> 'D' Box ------------ Type Filter Material --------------------Depth Filter Material -------------------------------------------- <br /> Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line ---------------......... <br /> SEEPAGE PIT ( ] Depth ----.- ------ Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No .0 <br /> Water Table Depth ---- -------------------------------------------Rock Size -------------------------------- <br /> Distance to nearest: Well z..=-=----------------------------------Foundation -------------------- Prop. Line --------------------_ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ---------------------7---------------------- Date ------------- ._-_---.---_----_-J <br /> Septic Tank (Specify Requirements)r_, _,,_________- <br /> r <br /> - --------------------- -- <br /> =Posal Field (specify Requirements) _- 1�G7?"�M`_---.- -�-____..__-__�_ <br /> 4Za ` ^ - <br /> -----t---�'--------- --- -------------1° �� -------- <br /> ------ <br /> - <br /> t -- ------------------------------ -- ------------------ --------- <br /> 3 X - ------ -- ------ <br /> (Draw xi tin 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 beco s ject to War7,ns mpensation laws of California." <br /> Signed ..-- -- - ---------- -- ------ Owner <br /> By Title <br /> other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------- --------------------------------------------- -------- - DATE f-------------- <br /> BUILDING PERMIT ISSUED ------------------------------------------------------------------I---- --- ------------------------------DATE -------'------------------------------ <br /> ADDITIONAL COMMENTS ------------------------------------------------------------------------------------------------------------------------------------------------ -- ------ <br /> ------------------- ---------------------------- -------------------------------------------------------------------------------------------------------------------------------------------- - ----.----- <br /> ---------------------------------- ------- <br /> - } <br /> Final Inspection by. <br /> Date - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />
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