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7837
EnvironmentalHealth
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ALEXANDRIA
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4200/4300 - Liquid Waste/Water Well Permits
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7837
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Entry Properties
Last modified
6/10/2019 10:10:10 PM
Creation date
12/5/2017 5:28:39 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
7837
PE
4211
STREET_NAME
ALEXANDRIA
STREET_TYPE
PL
City
STOCKTON
SITE_LOCATION
ALEXANDRIA PL STOCKTON
RECEIVED_DATE
07/31/1956
P_LOCATION
MCDANNUAL
Supplemental fields
FilePath
\MIGRATIONS\A\ALEXANDRIA\0\7837.PDF
QuestysFileName
7837
QuestysRecordID
1636982
QuestysRecordType
12
Tags
EHD - Public
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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> Date Issued <br /> Applica+ion is hereby made to the San Joaquin_Local -Health District fora permit-to construct and install the work herein described <br /> This application is made in compliance w' County Ordi, nanFe <br /> No549GOCATIO eXJOB ADDRESS C, K, <br /> Owner's Name----_mac.. ........ ..!. -::__ ----- - Phone <br /> �•�- <br /> Address.•................. -------•--• ...... . -- <br /> --------- -------- - <br /> Contrector's Name r ..------•--------- PhoneAk <br /> Installation will serve: Resid ce ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 171 <br /> Number of living units: ........ Number of bedrooms -------- Number of baths ---!_. Lot size ..__....___"...........................................•- <br /> Water Supply: Public system [r'fommunity system ❑ Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe4Q--Hardpan ❑ <br /> Previous Application Made: Yes M_—No ❑ New Construction: YescB- 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/ Distanc from fo ndation._,/l?_�______.Material.. <,-___ %s! __-•;�_-- <br /> No. of compartments________ --___.__Size.....6_„7'_ !YLiquid depth------Z_.Q..........Capacity...f__- __ __-- <br /> �w.o <br /> Disposal Field: Distance from nearest welV�_ ..!7__Distance from foundation._1 ........Distance to nearest lot line---._'"---••- <br /> Number of lines..----------/.._____. _ g T <br /> .__ ____.____Len Length of each line______..__�______________Wldth of trench------,2.•4_____.__.___._.___ <br /> Type of filter materialse_<_..Depth of filter material___.- ..........Total length_______-__7.,:S7._'.................. <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line................. <br /> ❑ 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 /> Remod ling and/or repairing (describe) 1-A 1 ------•••. ---------- ---• --- -•---- ----- ------ <br /> ---------------• zt --------------- <br /> ---- <br /> ..........Y�----- ....... --- -------- -- - - - -- <br /> r <br /> I hereby certify that I have prepared thistalication and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and r ulations of the San Joaquin Local Health District. <br /> (Signed) -_--�- ------. ----- ----------- (Owner and/or Contractor) <br /> _. <br /> By:.... - (Title) <br /> . .......... ........•---•------- ------ -----.. _ ..- ----------- -------- ----- ----- - - - --------------------- <br /> (Plot plan, showing size of lot, locate of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- ------------ --r <br /> - ----- --••----- ------------------------------------ DATE--------- - 6q <br /> - ---------- <br /> REVIEWEDBY--------------------------------------------------- - --------- -- ---------------------------------•------- DATE....•-------------• --•---•. <br /> ------ <br /> BUILDING PERMIT ISSUED.........................•--- ------------------------------------------------------- DATE•------------------------------ <br /> ---------------------------- <br /> Alterations and/or recommendations:--------------------------------------- -----------------------------------------------------------------------------------------------------\---------------- <br /> -------------------------------------------------------------------- ------------------------------------•------•------•----------••••---•--------••-------•------•--•-------•----•-•--••--•---•-•------•--••-.....----•.._.. <br /> --------------------------------------------------------- -----------------------------------------------------------------------•--------•------...----------•-----•----•--••-------•----•-•-•---------•-----•-••----------. <br /> -----•-------------------------------------------------------------------------------------------------------------------------------------------------•------------ -•-------•-•••-------•---•-----------•---•-----•-••------ <br /> ------------------------------------------------------ ------ ----- --_. ---------------------- ---------------------------------------------------- <br /> FINAL INSPECTION BY:. --------- -------0---------------------------------------------------- <br /> SAN <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California, Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 145446 ATWOOD 12-54 <br />
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