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21196
EnvironmentalHealth
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ELLIOTT
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4200/4300 - Liquid Waste/Water Well Permits
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21196
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Entry Properties
Last modified
1/4/2019 10:04:11 PM
Creation date
12/5/2017 12:54:46 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
21196
STREET_NUMBER
20319
Direction
N
STREET_NAME
ELLIOTT
STREET_TYPE
RD
APN
05121027
SITE_LOCATION
20319 N ELLIOTT RD
RECEIVED_DATE
10/21/1966
P_LOCATION
C O GREENE
Supplemental fields
FilePath
\MIGRATIONS\E\ELLIOTT\20319\21196.PDF
QuestysFileName
21196
QuestysRecordID
1730730
QuestysRecordType
12
Tags
EHD - Public
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FOR OFFICE USE: <br /> ------------------------ --------------- --------------- 12--// <br /> r <br /> APPLICATION FOR SANITATION PERMIT Permit No. .. ......... <br /> -------------- -------------- <br /> { <br /> -- --------------- <br /> -- - ----- ----------- ------------ <br /> ----- ----- - ----- --- (Complete in Duplicate) Date Issued <br /> Date Issued <br /> ----- ------------ ---------------------------- - ----- This Permit Expires 1 Year From - <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 with County Ordinance No. 549. )q-,I/),A-) , OS/ Z t 0 --2-7 <br /> 16 31 0- F-u-t 07T "j , t <br /> JOB AD RESS AND LOCATION! - A a -���". -- �------------------ --=------------------------------------------------- <br /> / ~ � I <br /> Owner's Name--- Phone <br /> s <br /> Address ------ ----- i <br /> ------•------------------------------------•------------ <br /> {-------- <br /> Phone...........--------- <br /> Contractor s Name--.-.-.. . <br /> Installation will serve: Residence lM Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ + <br /> Number of living units: -_�.... Number of bedrooms --:1... Number of.baths .-l_. Lot size . ....... ....... ._.....----...-._..._. ., Q <br /> Water Supply: Public system ❑ Community system ❑ Privates„[-De h to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ [ <br /> Gravel ❑ Sandy Loam Clay Loam E] Clay E] Adobe ❑ Hardpan � [ <br /> 4 [I ❑ 14 <br /> Previous Application Made: {lf yes,dote-----------:--------a No F1 New Construction: Yes No FHA/VA: Yes ❑ No ❑ ,Cj ' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ! <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ✓ <br /> E <br /> Septic Tank: Distance from nearest well--_ __...Distance from foundation---/A7..�-.-_....Material------ .c.. -------------- <br /> No. of compartments---------Z------ ----Size.��._1/-_~J(..�f X-5-�--Liquid depth------ --- -------------Capacity---Ix <br /> f <br /> Dispos Field: Distance from nearest well.--_,JC1.�-._Distance from foundation----f_.�.�-.-----Distance to <br /> Field: Distance lot line.�r�.�.-_.__... ► <br /> Number of lines-----------r.-------------------Length of each line--/aO-------------------Width of trench--Z-."------------------------- <br /> - <br /> Type of filter material-------- .t- .......Depth of filter material-.: . length------1.4�-a-------------------------- <br /> Seepage Pit: Distance to nearest well..--------------------Distance from foundation....................Distance to nearest lot line----- <br /> _---------- <br /> --- <br /> ❑ Number of pits----------------------Lining material-----------------------Size- Diameter-- -------------------Depth----------- ---- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation---.-----.._____..Lining material..-__-_-_--.-..__--....--- <br /> -. alk. <br /> ❑ ``Size: Diameter------ ----- -------- ------ Depth --------------- ---------- ------ ------------Liquid Capacity --------------------- g <br /> Privy: Distance from nearest well .................._-_.----.----------------- - Distance from nearest building__.__.-....------....._-..-----.-.------. <br /> ❑ Distance to nearest lot line--------------- ------------- -------------------------------------------------------------------------------------------------------------- - <br /> Remod6ngand/or repairing (describe --------------- -- ----------------- ----------------------------•--------•-----------------------------------------------------------•------------- - <br /> 4 ------------------------------------------------------ <br /> f ----------------------------------------------------------------------------------------- <br /> I ----------------------------------------------------•------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ` ordinances, State laws d rules and regulations of the San Joaquin Local Health District. <br /> i Contractor) <br /> nd/or for <br /> (Signed)----------------- -- ---------- <br /> By.------ <br /> �"'f = ----- {Title( <br /> (Plot plan, showing size of lot, location of system in relation wells, buildings, etc., can be placed on reverse side). <br /> I FOR DEPARTMENT USE ONLY <br /> I" <br /> APPLICATION ACCEPTED BY..-- ' <br /> DATE--- � - �1' �------------------- <br /> REVIEWEDBY------------------------------------- -------------------------------------- DATA <br /> BUILDING PERMIT ISSUED-------------------------- ---------------- ------------------ DATE <br /> Alterations and/or recommendations:----------•---- -- -- -----------------------------•-----------------•-- --------------------------------------- <br /> ----------------- -------------•-------------------------------------------- ------------------------------------------------------------ •------------------------------------ <br /> ---------- ------ --------------------- ------ -------------------- ------------------------- <br /> --------- --- -------------------- ------- ----------------------------`-- - ----- ----------- ----- - <br /> FINAL INSPECTION BY:.._- -------- - - Date- ----------------- - -------- -------- --------------------- ---------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxelton Ave. 300 West Ook Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> r.P.CO. <br />
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