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74-577
EnvironmentalHealth
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BACON ISLAND
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17700
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4200/4300 - Liquid Waste/Water Well Permits
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74-577
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Entry Properties
Last modified
4/15/2019 10:06:35 PM
Creation date
12/5/2017 8:27:24 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
74-577
PE
4210
STREET_NUMBER
17700
STREET_NAME
BACON ISLAND
STREET_TYPE
RD
City
STOCKTON
SITE_LOCATION
17700 BACON ISLAND RD
RECEIVED_DATE
07/05/1974
P_LOCATION
VERN L & DOLORES R SUNDSTROM
Supplemental fields
FilePath
\MIGRATIONS\B\BACON ISLAND\17700\74-577.PDF
QuestysFileName
74-577 (2)
QuestysRecordID
1655980
QuestysRecordType
12
Tags
EHD - Public
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/ 2c7-i-7o- 13 <br /> -r t FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit.No.71�' J 7 <br /> .. <br /> .......................... <br /> - .:.7.��..... <br /> ..... .• ......................... This Permit Expires 1 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 <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/L vie <br /> TION .....1.7.-�l,.-0;-- Q- R � c� CENSUS TRACY ..... . . <br /> j . . ... <br /> Owner's Name . .ss^ ... ...'L.-. t3.lt�.r..... ..�� lAi'1' .S.4..1r J t^w...............Phone .46.�,3.C1`1.`? <br /> Address ................ ........................................................... City ..........................................•........... . <br /> .. ................... <br /> Contractor's Name ..... ........ .............--...----•....-.............••......................License Phone <br /> Installation will serve: Residence ❑Apartment House 0 Commercial InTraller Court i❑ <br /> Motel ❑Other ...•........................................ <br /> Number of living units:............ Number of bedrooms ............Garbage Grinder ............ Lot Size .............•............-...... <br /> , , l ........... <br /> Water Supply: Public System and name ....L R�t-......................................._........._........................•.................Private (] <br /> Character of soil to a depth of 3 feet: Sand D Silt❑ Clay ❑ Peat❑ Sandy Loam V- Clay Loam [] <br /> Hardpan ❑ 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 <br /> ] �� ize.................................•.............. liquid Depth .......................... ,J <br /> Capacity <br /> ............ .................... Material---................... No. Compartments .................... ..1 <br /> .. <br /> Distance to neare ell ..Found ion . ... Pro Line d <br /> LEACHING LINE [ ] �..."...... D <br /> No. of lines -.-..-., ............. Length of each line......... d ..... Total Length d <br /> 'D' Boxype Filter Material <br /> -- T .•..................Depth Filter Material <br /> Distance to earest: Well ..../ �, /.d rr�- ..-.. Property line ... Qa <br /> � 9 <br /> ... <br /> SEEPAGE PIT [ ) Depth .. ...- ..--. Diameter � .• .. Foundation ...... Number .............. Rock Filled Yes"a No <br /> Water Table Depth0710../•_- <br /> ............. `. ...`..............Rock Size <br /> Distance to nearest: Well.......C; .................Foundation '... Prop. line <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date 1 ) <br /> Septic Tank (Specify Requirements) <br /> Disposal Field (Specify Requirements) ..... <br /> . .....-................ <br /> .. •...••...-•. <br /> ..•..............................••.......-.............-......•.-•.•...-........--_._........•......•-•-...._. <br /> ..-•...................... .......................... .....................................................................-••..... .........•..........................-_. <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that 1 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 /> "1 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 becom subject tZWwkman'sn nsatlon laws of California,"Si ned .. v�•............ . . Owner <br /> ....................... <br /> By ..... .... ................................ ...............................•.......................--.. Title . . <br /> . -........-................................-. <br /> (If other than owner) ........... ............. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .........................•. <br /> /............. DATE ..... <br /> -� <br /> BUILDING PERMIT ISSUED •� •- •-•----•' "" - ' """""" <br /> ..... ............... <br /> D TI AL CO MENTS •......................... DATE ............................... ....-.. <br /> ,r,,..,....... <br /> ..... .tf �r!'1�:�►-�.�. ....A!Lt. tc••AA, I.... „c. .,�/l0•••--• <br /> Ail l : .... <br /> al�9ftspection y: .........•-•••.......... �j..... 1.. ... ................................................... ........................... ........ <br /> Date ................. ...................... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H.13 241.'68 Rev. 5M 7/72 3 M <br />
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