My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
17543
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
B
>
BIRD
>
29281
>
4200/4300 - Liquid Waste/Water Well Permits
>
17543
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
12/16/2018 10:07:45 PM
Creation date
12/5/2017 9:54:13 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
17543
PE
4211
STREET_NUMBER
29281
Direction
S
STREET_NAME
BIRD
STREET_TYPE
RD
City
TRACY
SITE_LOCATION
29281 S BIRD RD
RECEIVED_DATE
06/08/1964
P_LOCATION
DONALD PETZ
Supplemental fields
FilePath
\MIGRATIONS\B\BIRD\29281\17543.PDF
QuestysFileName
17543
QuestysRecordID
1664130
QuestysRecordType
12
Tags
EHD - Public
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
2
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
FOR OFFICE USE: <br /> ----------------------- ------------------------- <br /> APPLICATI AR SANITATION PERMIT Permit No. <br /> ----------------------- (Complete in Duplicate) <br /> Date Issued <br /> ---------------- --------------- This Permit Expires 1 Year From Date Issued- <br /> -- ---- <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein de;scribed. <br /> This application is made in compliance with County Ordinance No. 549. 2�149_ 1 � <br /> JOB ADDRESS AND LOCATION--- _(?w...... --------- --------- <br /> Owners Name_=----.-.-------.--------------- ---- <br /> ---------- ---•------------•------------------- <br /> ---------- Phone <br /> -/ ------------------------------------ ------------------------------ -- <br /> ------------------------------------I----------------- -------------- --- --.-.-.-.-.-.-.-.-.-.-.Address------ . . ...... . ......------------- - <br /> • <br /> f <br /> Contractor's Name--------------------- ---------**--------- 7--------------------------------------------------------------.. Phone--------------------- ------------- <br /> Installation will serve: Residence Apartment House [] Commercial E] Trailer Court L] Motel El Other 0 <br /> Number of living units: Number of bedrooms _9__ Number of baths A--------Lot size --- ------------------------------- <br /> Water Supply: Public system E] Community system El Private Depth to Water Table /_n ft. t. <br /> Character of soil to a depth of 3 feet: Sand [-] Gravel E] .Sandy.Loom El Clay LciamA Clay [I Adobe Ej Hardpan ❑ <br /> Previous Application Made: (if yes,date____________________) Not ' New Construction: Yes M—No El FHA/VA: Yes D NoX <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Wit- <br /> ------------- <br /> ------------------------- <br /> ---------- <br /> Se i Tank: Distance from nearest well____ - ------�Distance from founclation-A Mater.ial- <br /> ptic/ 3 Y <br /> No. of compartments--_ ------------ -------�L Liquid depjh____-5__"___ --------Capacity--j -.4 <br /> Ai"477-1--------/�. — 1119 <br /> 3e) Z. <br /> Dispy' I Field: Distance from nearest well__ ........Distance from foundation------qVIV.Disfance to nearest lot line----------------- <br /> Number of lines-3.-------------- ----- ----Length of each line____�n---7-4p.,�-ICYRidth of trench - -- ------- <br /> Type of filter material '. -�_-Depfh of filter maferia <br /> 7 - -------I--------------------- <br /> ferial-5 I---I_Y_"_4.__TotaI length-_.----,, <br /> Seepage Rit; Distance to nearest well----------------------D 1%isfance from f.ounclation---------------------Distance to nearest lot line-1-Z--------- <br /> ❑ Number of pits-_-------------------Lining:material----------- -------- - Size: Diameter_�----------------------Depth-------------------11;-------------- <br /> V ---------------- -.1ining material-----------------------11--------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation <br /> .............. - - ---------------- -------gals. <br /> El Size: Diameter------------------ ------ - ----------Depth ------------------- -------------Liquid Capacity <br /> _""Distance <br /> ;;;�. I = 7L. --- 7�-� -- - -- !�_. -�1,,- .— W�----.- -pry <br /> Disfan 6�cZ from nearest building-_____________.-__________.____-__-----.' __ <br /> ce fi8�m�lnta'�re_sf well._._____________--------------------------------Dist 117 <br /> ElDistance to nearest lot line--------------------------------------------------------------------`----------------------- -------=----------------------- -------------- <br /> Remodeling and/or repairing (describe):-----_-----------_-------------------------------------------------------------------------------------------------------------------- -------- <br /> 7----------—---------------- ---------------------------------------------------------------------------------------------------I-------- ------------------------------------------------------------11--------------- <br /> ------------- ------------------------------------------------------------------------------------------------------------------------------------------ ---------- ------------------------------------------°--------- ----- <br /> ---------------=-------------------- <br /> ----------------------------------------- --------------- <br /> ------------------------------------- ------------------------------------------------------------------------••----------------------------------------=----------------------------•---------------- ------ <br /> 11----------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaqu!' County <br /> ordinances, Stat -laws, and rules and-�egulafions of the San Joaquin Local Health District. <br /> ractor) <br /> --------------------------------------I---------------(Owner and/or'C6nf <br /> (Signed] -------------------------------------- ------------ <br /> By:---------------------------------------------------------------------------------- -----(Title]------------- ---- ------------ _-_ --- --- ----- --- <br /> (Plot plan, showing size of lot, location of system in relation to wells, 6uildings,etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTIED BY----.__.----'--- :----------------------------- <br /> ---------------------------DATE- <br /> BY-----------------------------------------------I------------- -------------------------------------- DATE--- --------r_11--------------- <br /> BUILDING PERMIT ISSUED------------------------------------- ; 6 q. <br /> Ale----------- ----- ------------------ DATE---------------------- ------------------------------------- <br /> Alterationsand/or recommendations-----------------------/----- ---- ------ ------------------ ---------------------------------------------------------------------------------0_----------- <br /> ------------------------------- ------------------------------------------- ---------------------------------------- ------------------------------------------------------------ ------------.......................... <br /> --------------------------------------------- ------ ----------- ----------- - -------------------------------------------------------------------- ------------------ --------------------------------------11----------------- <br /> K :I: <br /> ---------------------- ------ ------ -------------------------- :7---------------------------------------------------------------------------------------------------------------------------- ----------------------------- <br /> -------------------:--------------------------------------- --- ----- --- <br /> ----------- -*------------------------------------------------------ ---I------------------------------------- ---------- <br /> FINAL INSPECTION BY:. ------------- ------ --------- ----------- ------- Date- <br /> ----------- --------- ------- -------------- <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 /> ES 9 REVISED 9-59 3M 3`63 F.P.C13. <br />
The URL can be used to link to this page
Your browser does not support the video tag.