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4200/4300 - Liquid Waste/Water Well Permits
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20909
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Entry Properties
Last modified
1/2/2019 10:10:48 PM
Creation date
12/1/2017 2:50:09 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
20909
STREET_NAME
YOSEMITE
STREET_TYPE
AVE
City
MANTECA
SITE_LOCATION
YOSEMITE AVE RT 3 BOX 33 M
RECEIVED_DATE
07/21/1966
P_LOCATION
WALTER KEPPEL
Supplemental fields
FilePath
\MIGRATIONS\Y\YOSEMITE\0\20909.PDF
QuestysFileName
20909
QuestysRecordID
1997061
QuestysRecordType
12
Tags
EHD - Public
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FOR OFFICEtUSEf <br /> F. <br /> APPLICATION FOR A'NITATION PERMIT Permit No. .___ _d_. 49 <br /> - Com' late en ¢ <br /> & r, ;Duplicate);' <br /> R- 3 Date Issued <br /> -.- This permit Expires 1 Year„pram Date Issued <br /> Application is hereby made to the San Joaquin Local Health Dist ri'ct`for._a'permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance 4o <br /> JOB ADDRESS AND LOCA <br /> TION----------- <br /> Owner's Name------- <br /> - P <br /> � - r <br /> - one <br /> Address = �� � '��----- ----------------------------------------------------- ----•- ... <br /> n = ) _ <br /> Contractor's Name -1']r l L ------------------- `----- '== --------------------------------------------------- ------------ Phone---rZ _ ,---- <br /> Installation will serve: Residence) �. Apartment House ❑ Commercial- El Trailer Court ❑n Motel ❑ Other E]Number of living units: ---t____ Number of bedrooms _ lumber of baths __l____ 'Lot size --. UEAGZC______________--____ <br /> Water Supply: Publie"system ❑ Community system ❑ Private Depth to Water Table __f _ ft. <br /> Character of soil to a•depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan <br /> ,14 <br /> Previous Application Made: (If yes,date____________________) No ew Construction: Yes-E. No FHA/VA: Yes ❑ No�E � <br /> - _-...-TYPE OF INSTALLATION AND SPECIFICATIONS: '0" <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> h <br /> Septic Tan Distance from nearest well____ ___jDistance from undation---5-___.-------Mate�aL__CDNC_R_rR- -_.-_____� <br /> o. of compartments---------_t______________Size- __X___ _ . _;_ <br /> _�_ . __Liquid depth__-,'5----- -------------Capacity_____2 <br /> Dispcsal Field: Distance from nearest well_L�_____Distance from foundation--------------------Distance to nearest lot line_________________ <br /> ❑ Number of linesf---------------------------------Length of each Fine------------------------------Width of trench---------------_:------------------ i <br /> Type.of filter material__________________ Depth of filter material----------------------,Total length_______________ Qs ' <br /> Seepage Pit: Distance to nearest weil_._U_~�_--------Distance from foundation____ G_______-Distance to nearest lot line_------_________ <br /> plumber of its._ Linin material-_ jl`�'.. .__.Size: Diameter___ rn <br /> P g '� �/r/-- - Depth- - -----.4-------- ---------- 1" <br /> Cesspool: Distance from nearest well___________ ___Distance from foundation-------------------.Lining material-_-_---__________-_ <br /> ❑ Size: Diameter,-.]--------------- -------Depth -------------------------- ---------------------Liquid Capacity----------------------------gals. <br /> i <br /> Privy: Distance from nearest well-------_-----___---___.______.__.__ --_._.-___._Distance from nearest building-------------------------------------- _ ' <br /> ❑ Distance to nearest lot line----------------- - --- -------------------------------------------- <br /> Remodeling and/or repairing (describe):- p __.A13A'r�------__MA_,D�------- <br /> _ <br /> ---------- -----------gni 4y - A---N-K-------#`--- F 9G/-� �/.�c,�,D-- ---- <br /> -0 <br /> --- j <br /> - = ---------------- ----- <br /> ------------------------ ------=--------------------------------------- ---------------------- --------Tc- -------�------------------------------------------------------------ ---- - ---------- <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, and rules-and regulations of the San Joaquin Local Health District. <br /> (Signed)---- <br /> - = � ', .(Owner and/or Contractor) <br /> By:---------------------------------------------------------------------------- ------ -------------{Title) ------- ------- --......................... ------ ...- <br /> --------- ------------------------ <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 /> APPLICATION ACCEPTED BY----- 'c ��--- ---------------------------------------------------------------- <br /> DATE ---7-7-- ---1----k�---------------- ! <br /> REVIEWEDBY-------------------------------------i;--------------------------------------- ------------- --------------------------------- DATE---- --------------------- <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations{_-_= .T,?t._ � _WEE-ISS______ ________ L��,4-!_ ._____ _ - _-------------- <br /> --------------------------- --------- ------------------ <br /> ------------- ------------------------------ <br /> ------------------------------- ---- --..-.-._.: <br /> FINAL INSPEC --------- ------ Date-------- ---------- <br /> SAN <br /> --------SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. I <br /> 11 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.C C. <br />
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