My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
73-1054
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
A
>
ADELBERT
>
1734
>
4200/4300 - Liquid Waste/Water Well Permits
>
73-1054
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
3/28/2019 10:06:22 PM
Creation date
3/20/2018 10:29:11 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
73-1054
PE
4210
STREET_NUMBER
1734
Direction
S
STREET_NAME
ADELBERT
City
STOCKTON
SITE_LOCATION
1734 S ADELBERT STOCKTON
RECEIVED_DATE
11/8/1973
P_LOCATION
C WALKER
Supplemental fields
FilePath
\MIGRATIONS\A\ADELBERT\1734\73-1054.PDF
QuestysFileName
73-1054
QuestysRecordID
1631157
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 /> APPLICATION FOR SANITATION PERMIT <br /> Permit No. ........ —/aS� <br /> ftM (Complete in Triplicate) <br /> �.. ......... .............::... `O Date Issued . ..8" 3 <br /> ...... !�� This Permit Expires 1 Year From 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 /> _ /. <br /> JOB ADDRESS/LOCATION ...... 7...?'. ,� .4� ,4 <br /> ... .lam..... ... ......... ......................CENSUS TRACT .......................... <br /> Owner's Name •................... .......Phone <br /> Address -.....5"G{"!, [r...:......•. ....••••........ ...._.._.........rCity ...............••• ....-••••-••••................. ................ <br /> Contractor's Name .... .,�i.,/�,rA/'................ License # Phone <br /> ....... ...........••-•••...... .............................. <br /> Installation will serve: Residence X Apartment Hguse❑ Commercial ❑Trailer Court 0 <br /> Motel ❑Other ......... <br /> Number of living units:—/..... Number of bedrooms -....Garbage Grinder 11C14P.. Lot Size,f Q:4�Cr........................ <br /> Water Supply: Public System and name 44/,/Q....410rc.0--_% ...........................................Private* <br /> Character of soil to a depth of 3 feet: Sand 0 Silt❑ ',Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobeg 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 I j Size................................................ Liquid Depth .......................... <br /> Capacity .................... Type ..............••.... Material...................... No. &�rtpartments ........-•-...........J <br /> Distance to nearest: Well ....................................Foundation ...................... Prop. Line ......................W <br /> LEACHING LINE [ j No. of Lines ........................ Length of each line............................ Total Length ............................ <br /> 'D' Box ............ Type Filter Material ....................Depth Filter Material ............................................V1 <br /> Distance to nearest: Well ........................ Foundation ........................ Property Line ........................ <br /> SEEPAGE PIT [ ) Depth . . .... ❑ <br /> . . ............ Diameter .__..:..._...... Number' ............................ Rock Filled Yes No <br /> Water Table Depth ...Rock Size Q' <br /> Distance to nearest: Well ..........•.............................Foundation .................... Prop. line ......................� <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ....................... !.......__.._.. Date •...... ............................ <br /> Septic Tank (Specify Requirements) .................. N-Sirl '`" <br /> r .� <br /> Disposal Field (Specify Requirements) ._ .. h � �n�� ., r71 ''/1. gt`. ......1 ......... <br /> c-------------------------------------•---...----------------.... ..... ....�. ........._.................... <br /> ................... ......................................................................................................_.......................••-- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I 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 /> "I certify that in the performance of the work for which titin permit is issued, 1 skall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws olf'611fornlil." <br /> Signed <br /> .........-........ .. ............. ................ Owner <br /> By --.._.. ....... ................................ <br /> .r.. ................-- <br /> . C <br /> ( than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED Y .._ DATE <br /> .......-••••••I........................ ....... <br /> BUILDING PERMIT ISSUEq :d... ...' <br /> ..............................................................................................DATE ........................................... <br /> ADDITIONALCOMMENTS...............................---.....................-•••--....._.......••••.... ....,..................................................•••...... ... <br /> �.z: .... <br /> ..................................... -..�• . -.. - ------�V ,r. ..........................•--....----.............. ............... <br /> Final Inspection by: .........................................Date .......�/..`�.._.?.3......--••- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT *%k <br /> E. H.13 241-'68 Rev. 5M 7/723 M 43 <br />
The URL can be used to link to this page
Your browser does not support the video tag.