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8499
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4200/4300 - Liquid Waste/Water Well Permits
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8499
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Entry Properties
Last modified
8/19/2019 10:10:00 PM
Creation date
3/20/2018 10:26:49 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
8499
PE
4210
STREET_NUMBER
131
Direction
S
STREET_NAME
ADELBERT
City
STOCKTON
SITE_LOCATION
131 S ADELBERT STOCKTON
RECEIVED_DATE
2/7/1957
P_LOCATION
L J MEAD
Supplemental fields
FilePath
\MIGRATIONS\A\ADELBERT\131\8499.PDF
QuestysFileName
8499
QuestysRecordID
1631493
QuestysRecordType
12
Tags
EHD - Public
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APPLICATION FOR SANITATION PERMIT Permi o. <br /> \� (Complete in Duplicate) <br /> Date Issued 2_ <br /> Applica{ion 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 <br /> �/No. <br /> 549. <br /> JOB ADDRESS AND OCATION........ 1----------°`5� ------/T__44- J�—_b--e—z2wt........................................................................ <br /> Owner's Name ....... <br /> ----------------------------------- ------------------------------------------- Phone.................................... <br /> Address------------------� ....... 3 ? / - <br /> Contractor's Name <br /> ... :---!&-IV-----''"T------------- -------------------------------------------- Phone................................... <br /> Installation will serve: Residence Jo Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ........ Number of bedrooms _Z-.-Number of baths _/___ Lot size ____' 1 _���C�_______________ <br /> Water Supply: Public system 0-.Community system ❑ Private ❑ Depth to Water Table _&-oft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan <br /> Previous Application Made: Yes ❑ No E--New Construction: Yes L&,_No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Ta k: D' ce from nearest well__;______________Distance from foundation....................Material___-_-______-_____-___•,_______,__-_--_____-_____- <br /> o. o ompartments--------------------- ----Size--•---••-------•--------•-------Liquid depth--------------------------Capacity-•------•-------- <br /> Disposal Field: D ante from nearest well_-........._----Distance from foundation--------------------Distance to nearest lot line................. <br /> ❑ of lines-----------------------------------Length of each line---_----------------- -----Width of trench---------___-------_--------------- <br /> �Typ f filter material-------------------------Depth of filter material----------------------- length.......................................... <br /> Seepage Pit: Distance to nearest well_/uD?-.q,_Distance from fourjdation_____cD_______.Distance to nearest lot line__...�<d1_. <br /> Number of pits__/______-_._._-Lining mate ria l__�Gfe: Diameter___-�-T_��_-Depth_____Gs��____._______ <br /> Cesspool: Distance from nearest well__________ __ ..-Distance from foundation--------------------Lining material_ ------- _____-________ <br /> ❑ Size: Diameter---- -- ---- ------ -----Depth------------ ----- ---------- ----Liquid Capacity --•- •........gals. <br /> Privy: Distance from nearest well-__-___-_-__-__ _ <br /> ________________________Distance from nearest building..____ __:.._.___.._________:{ <br /> ❑ Distance to nearest lot line------------------ -------------------•-------•----•----•------------•-----------------------:----------------------------------------- <br /> Remodeling and/or repairing (describe :--------- -----------------•------............................................................ ------•------•-----------•---------------------•-- <br /> --- ----•-----•------•-•------------------••---•------•---•------------ ------------•--------•-----•---•-----------------------_----- <br /> -----•--------------•----•------------------------------------------•--------------------------•-•--------------------------•------------•--------•----------------------•------•-------------------•----•--•----------------- <br /> ------•-- ----------------------------------------------------------------•--•------•----------------------------___--------•----------------•--•-------------------------•----•-••---•--•--•--••••-•--•-•••-------....... <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, Sta ws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signe ------� - ------------------------------------- ------(Owner and/or Contractor). <br /> vByv:- .........I--&—�-� .— �.� Cz� - -------------------(rtleD --_--- ------ <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------------------------- -----------------------------------------------................_ DATE----,,„ <br /> REVIEWED BY - - ----------------------- DATE----------�-�� <br /> BUILDING PERMIT ISSUED--_---------•----------------- DATE-----------_-- -__ -� <br /> ------------•--------------------------------------- ---------------------- <br /> Alterations and/or and/or recommendations---------------- -- ----------------- --------•-----••------••-•-----------------------•----- ---- --- ��' <br /> ::-:::::::-------------::: :::: ::: :: -::::art----- ::= . - :- - --- - -----------.--.----------..----.-----.---------------------------.-------.-----.------------------------------------------------------------------------.---------:. <br /> - ._-._---•--------------- ` --------------------------------------------------------------------------------------------- --------------- <br /> 5� .:. --- -�. --• ?---9- <br /> FINAL INSPECTION BY:. Date I------------------------ <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 145446 ATWOOD 4 <br /> •.f <br />
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