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10071
EnvironmentalHealth
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BISHOP
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2122
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4200/4300 - Liquid Waste/Water Well Permits
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10071
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Entry Properties
Last modified
10/17/2018 8:37:17 PM
Creation date
12/5/2017 10:05:18 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
10071
PE
4210
STREET_NUMBER
2122
STREET_NAME
BISHOP
City
STOCKTON
SITE_LOCATION
2122 BISHOP
RECEIVED_DATE
08/26/1988
P_LOCATION
GEORGE LAINE
Supplemental fields
FilePath
\MIGRATIONS\B\BISHOP\2122\10071.PDF
QuestysFileName
10071
QuestysRecordID
1665531
QuestysRecordType
12
Tags
EHD - Public
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APPLICATION FOR SANITATION PERMIT Permit No. ... <br /> O (Complete in Duplicate) <br /> Q � <br /> a - - <br /> Date Issue -- ---------------- <br /> d <br /> Y <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. '549. <br /> / ---------- -`-- Z�Lla----_""-__-__-__------- - <br /> ----- <br /> ----------- <br /> Address--,..", <br /> . <br /> .JOB ADDRESS AND CATION------- -------- <br /> Owner's Name -,-- - Phone <br /> Address -------------- <br /> / <br /> r - -------------------------------------------------•----._--.._ <br /> Contractor's Name------------------ - _ P h o n 1,21d Zt17 a- <br /> Installation will serve: Residence Apartment House E] Commercial ❑ Trailer Court E] Motel ElOther ❑ <br /> Number of living units: ____ Number of bedrooms _n-Z Number of baths Lot size ____ _ _ _____________________ ___ <br /> Water Supply: Public system [EEj.., Community system❑ Private ❑ Depth'to'WaterlTable .',ft� ft: v <br /> Character of soil to a depth of 3'feet:' Sand ❑ r Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe �ardpan ❑ <br /> Previous Application Made: Yes ❑ No [+ ew Construction: Yes ❑ No "FHA%VA: Yes ❑ No ❑ <br /> } TYPE OF INSTALLATION AND SPECIFICATIONS: a r <br /> (No septic tank or'cq.sspool permitted if public sewer is available within 200 feet.) <br /> ti nk: Distance from nearest well----------------- from foundation__:_c______-1.__.__.Material____.___ "______________________________ <br /> No. of compartments---------------------------Size-•------------------------------Liquid depth----------------------__..Capacity <br /> .... <br /> Z�.'L, ie,d: . Distance from nearest well_______----------Distance from foundation--------------------Distance to.nearest lot line---_-_._.--------- • <br /> Number of lines-----:1-------------- <br /> _ -------------Length of each,line------------------------------Width of trench.-------- ----------------------- f.� <br /> Type of filter material-______-- ____•_____ Depth of filter material----------------------- otal length________"-----___--___-___________-..__-- <br /> p g �P rf --------Di fa nearest lot line__ 4`__.,- <br /> See a e it: Distance to nearest well __ _______� Distance r m f undation___ <br /> p Lining material--- �---Size: Diameter___k� --------.Depth--..._a _.5---- ------------• <br /> Number of its-___1______. _ <br /> Cesspool: Distance from nearest well----=------------Distance from foundation---------------.---Lining <br /> ❑ DiameterF i material__._.___._-.__'-.____-__-.--_-___--.__. <br /> Size: --_--- ; - - ---------------- 'Li Liquid Capacity------------i----- gels. <br /> ' Priv Distance from nearest well----------------- ----_ -._.._Distance from nearest building <br /> ❑ - " - Distance to nearest lot line-.-.-_ - - <br /> - --ring (cle - --- ---- ----=------------ ----------- ------------ ----------------=--------------= ------•--------------------------------•- ------ <br /> Remodeling and/or repairing (describe}:__..__._______.___"_ <br /> 1 <br /> --------------------------------------•--- ------------- ---------------------------- --------------------------------- <br /> -------------------- --- _ = . a <br /> - --- --------- ------------ <br /> ordinances,bs rtilawsh and rules and re du <br /> ---------- ---------- ------------------------ <br /> i y y p p this application and that the work will be done in accordance with San Joaquin County <br /> g lotions of San Joaquin Local Health District. <br /> (Signed).. ,^-- j4K (Owner and/orContractor) <br /> BY:--------------- ---------- X/ ------ f ---------------- Title <br /> (Plot plan, showing size of Iof, to anon of system i. relation to wells, buildings, etc., can be placed on reverse side). <br /> -•` FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ---------------------------- r�---------- DATE--.-- <br /> REVIEWEDBY-----------------------•------ ---- ---- --- ---------------------------------------------------------------------- DATE -��— <br /> BUILDING PERMIT ISSUED-----------------------•--------------L-------------------------•----------------------- DATE.--------A ---------- <br /> Alterations and/or recommendations:------------------------------- --------------•---------i = <br /> ---------•-------.--"----------•-------------------------------------- ------------------------------------ ---------------------------------- --------------------------------------------- ------------------------------- <br /> ---------------- <br /> -----•-----------------------------•---------- ------ ----------------------------------------- , <br /> ---------------- ----------------------------------- - ------•----------•--------------------------------•---------------------------- •------------ --• •------------------------------------..._ <br /> FINAL INSPECTION BY_______ _ <br /> - Date- <br /> J SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> l Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M , Revised 1.57 U-CO. <br /> r <br />
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