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19360
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ESCALON BELLOTA
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9957
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4200/4300 - Liquid Waste/Water Well Permits
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19360
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Entry Properties
Last modified
12/25/2018 10:06:54 PM
Creation date
12/5/2017 1:35:19 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
19360
STREET_NUMBER
9957
Direction
S
STREET_NAME
ESCALON BELLOTA
APN
20703009
SITE_LOCATION
9957 S ESCALON BELLOTA
RECEIVED_DATE
08/04/1965
P_LOCATION
CASEY MATT
Supplemental fields
FilePath
\MIGRATIONS\E\ESCALON BELLOTA\9957\19360.PDF
QuestysFileName
19360
QuestysRecordID
1737594
QuestysRecordType
12
Tags
EHD - Public
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R OFFICE USE: <br /> --..-_-_ ------------ APPLICATION FR SANITATION PERMIT Permit No.......55-4-6 <br /> ------------------ ----------------------- -------------- (Complete in Duplicate) <br /> This Permit Expires i Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descrbed. <br /> This application is.made in compliance with County Ordinance No. 549. 2---7_030 <br /> 9Q,5`7 S FSc!4cn,n.l ,d oc-u�7-,4 <br /> J08 ADDRESS AND LOCATION______._.___ _ <br /> Owner's Name--------- �L ----------------------------------------------------------- - - -h _ <br /> -------------------------- <br /> -------- one <br /> Address------------------- -------- _-.' <br /> - - -77.1 "_-p-P-------------- <br /> Contractor's Name = ------------- J ----------- T- ---- <br /> Installation <br /> Installation will serve: Residence par ment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _t--_ Number of bedrooms _J---Number of baths -------- Lot size .-.----__- �__ _--___-.------_ <br /> Water Supply: Public system ❑ Community system ❑ Private 52--15epth to Water Table <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe M Hardpan 52--' <br /> Previous Application Made: (If yes,date--------------------) No New Construction: Yes 2E1-1�o ❑ FHA/VA: Yes ❑ No " <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic.Tank: Distance from nearest well-----------------Distance from foundation--------------------Material._..___-___-___.._.____..._.__._--_--__..____... <br /> No. of com artments----_ Si e_;____ Li <br /> �'��fzq P - ._-- ;< t --------- --- quid depth- ---------- -------Capacity ------------ <br /> Disposal Field: Distance from nearest well_.._- Distance from foundation--------------------Distance to nearest lot line__-_------_-. <br /> Numlaer of lines----------------------------------Length of each #ine--------- <br /> _2T........-_-Width of trench-------,2!---------------------- i <br /> Type of filter materialresG_Zdc/C_Depth of filter material__--/X'r--__.-Totaf length---__-_---__%.5�.- -__----__ <br /> Seepage Pit; Distance to nearest weli----------------------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> El Number of pits----------- Lining material------------------ --- Size: Diameter.-..-----,.------------Depth-----.-._._.__---__--.___..._ <br /> Cesspool; Distance from nearest well-----------------Distance from foundation---.--------------- Lining material___-_----------------------__- <br /> ❑ Size: Diameter------------- ------ ---------------Depth- ------------------------------- --- ------------..Liquid Capacity----------------- ----------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------__.--.-__.___----_-_-.--_-.--. <br /> ❑ Distance to nearest lot line <br /> _ _ I <br /> Remodeling and/or repairing (describe): rr� -gl�T���a� __1-------------------------------------------------------- <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 las, and rules and regulations oft San Joaquin Local Health District. <br /> R <br /> (Signed)- ( ----------------_-----_.__(Owner and/or Contractor) <br /> By------------------------- -------------------------------------------------------------------------------------------------- -------(Title)-------------------------------- ----- ----- ------- -- <br /> . k <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> r -------------------------------------------------------- DATE s <br /> APPLICATION ACCEPTED BY---- --� ---,�>�--- <br /> -- -- -- ' <br /> BY <br /> REVIEWED ER --------------------------------D -- ------- --------------------- ---------------------------------------------------------- DATE----------------------------------- - i <br /> - --------------------- <br /> BUILDING PERMIT ISSUED { --- - DATE--------r--------- <br /> Alterations and/or recomme datio s . ✓ cifl ----- - <br /> - �¢--------- <br /> 6' <br /> J� , <br /> - _ f n sx_ E <br /> -dS�-1 -=--�-L- -------------------------•--- ------ ----- - - <br /> ---------------------------P <br /> -- - --- - ----------------------------------------- <br /> ---------------------------------- <br /> -- <br /> - -------------- ------------------- --- -- - -- � <br /> FINAL INSPECTION BY;....... <br /> de2_,�: ------ --- Date--- ------------- <br /> ` y <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> •j <br /> F.P.L=, <br />
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