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EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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8035
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Entry Properties
Last modified
7/3/2019 10:47:15 PM
Creation date
12/5/2017 1:09:38 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
8035
STREET_NAME
EMERSON
STREET_TYPE
RD
City
ACAMPO
SITE_LOCATION
EMERSON RD NO OF LINDS AIRPORT
RECEIVED_DATE
09/19/1956
P_LOCATION
J C GAYDON
Supplemental fields
FilePath
\MIGRATIONS\E\EMERSON\0\8035.PDF
QuestysFileName
8035
QuestysRecordID
1732270
QuestysRecordType
12
Tags
EHD - Public
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APPLICATION FOR SANITATION PERMIT <br /> Permit No. ----•------••--•--...--- <br /> (Complete in Duplicate) Date Issued __9 <br /> Applica}ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> L e 1�ci✓3 17�.�i 7 Lie% ,5 r Cft <br /> This application is made in compliance with County Ordinance No. 549. 1. /o o f' Ld ! ",4 .,.1 <br /> JOB ADDRESS AND LOCATION_l►__.�_----BOX--�.�-�1--�-C�►'��b�' <br /> Owner's Name---T-------........... <br /> -- --•• <br /> .......... Phone------------------------------------ <br /> Address---------- -------------------_ ----------- <br /> ---------------------•----------------- <br /> las � � -'---- - one <br /> Contractor's Name------- " P <br /> Installation will serve: Residence impartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __ _-__ Number of bedrooms __Zr Number of baths ---L_ Lot,size -----------------------•------- <br /> Water,Supply: Public 'systerCommunity system- Depth to Water Table 7. ft' <br /> ri❑ <br /> Character of soil t o depth of 3 feet: Sand ElGravel El -,Sandy Loam El Clay Loam ❑ Clay 91—Adobe❑ Hardpan E] <br /> Previous Application Made: Yes ❑ No [ New Construction Yes KI-1-No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS. �F ; , <br /> (No septic tank or cesspool permitted if public sewer �s available within 200 feet.) ► <br /> F - - - -- - ------------ <br /> Septic Tank: .Distance from nearest well__.�Q__.-__Distance from foundation____ Q_�-.Material___ C�._ __-__ <br /> ' �C ---------Cit <br /> .G ------ G <br /> ,No. o ;compartmeS - p <br /> .l " p F -- -- r 3 fY Distance to nearest lot line.-__t` ____ <br /> Disposal Fie4d: �-- Distance from nearest well __._-...___.=Distance from foundation__- __.........: � <br /> `Nu ilzer of lines----- -L - - rr 1 -'Length of each line-3_��._�--?��--...Width of trench.__.-#-�1--�!-------- ,--- <br /> Type of filter material__-14..... �"Depth of filth r m eria!__.1-$------ - -Total len gth___._...-- •..- -�- ' <br /> • ..] <br /> _ r <br /> 3 - <br /> 4� <br /> Seepa it: Distance toinearest wellLf__6_f�'._._ __Distance from foundation .�-Q�_ .Dista��e to nearest lot line_.--Y-------- <br /> if: <br /> .--_: <br /> I _..Linin material__ai -L_ -ll :Size: Diameter.. _-...-____.1-0 Depth......- -~ <br /> pits---------�--._ g <br /> Distance frI <br /> �,f 'Number a <br /> s � <br /> Cesspool om well_-_____�_____.__Distance from foundat.ion.:-:— -. .:__.Lining material--------------------------------------- <br /> nearest th ----------------------------------- ------- --Li uid Capacify-... gals. <br /> t . ❑ Size Diameter------------------------ p q- P t? ' ' <br /> 4 . .:....... --- from nearest building <br />� .Privy: /'Distance from nearest ,Nell----------------------------------- - -': -------------------------------- . <br /> ,. •------••-- --------------------------------------------------- <br /> - <br /> --------------------------------------------- <br /> 'Distance to nearest lot line-'----'.--'--------'------------------------- ------•---- <br /> Remodeling and/or repairing [describe]:_. /Y_ --- <br /> 1 ----------------------------------------- <br /> r: 1 ---•------ ------•----- <br /> Z' 7 <br /> I hereby certify that I have prepared this application and that the work will be done in accordance-with San Joaquin County <br /> jR. —ordinances, State laws, andrulesand regulations of the San Joaquin Local Health District. <br /> g: ' -------- 4onre <br /> rand/or Contractor(signed)_ -----ocatin of s stent m relation (Tice).__.._ r•---------------•----- ---------- -(Plot plan, showing size of to+, I Yto we11s, buildings, etc., can be place and/or <br /> DEPARTMENT USE ONLY <br /> ' .. DATE------ ---------- ---------------------------------- <br /> APPLICATION ACCEPTED BY----------------------------- <br /> ---- ---- -- -- -------------• ----------- <br /> DATE--'-'- -�-:r---------------------------•------------ <br /> REVIEWED BY <br /> -------- <br /> DATE------'------ �--• --'------'------- ------- <br /> BUILDING PERMIT ISSUED----------•----------------------- --- <br /> Alterations and/or recommendations----_____,..._-.___- <br /> ------ ------------------------------•-------- ------------------------- <br /> -----------------------•---------- <br /> "'--------------------------------------•---- <br /> FINAL INSPECTION BY <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> 13D South American Street Y. California <br /> Trac <br /> Lodi, California Manteca, California II <br /> • Stockton, California `` <br /> I <br /> �_ ES-9 � 1454A6 AT WQtl� - <br />
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