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5903
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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4200/4300 - Liquid Waste/Water Well Permits
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5903
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Entry Properties
Last modified
1/31/2019 10:11:37 AM
Creation date
12/1/2017 5:45:14 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
5903
STREET_NUMBER
1528
Direction
E
STREET_NAME
PINCHOT
STREET_TYPE
ST
City
STOCKTON
SITE_LOCATION
1528 E PINCHOT ST
RECEIVED_DATE
1/12/1955
P_LOCATION
JAMES PINASCO
Supplemental fields
FilePath
\MIGRATIONS\P\PINCHOT\1528\5903.PDF
QuestysFileName
5903
QuestysRecordID
1899339
QuestysRecordType
12
Tags
EHD - Public
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n y 1 <br />APPLICATION FOR SANITATION PERMIT Permit No. <br />6 <br />(Complete in Duplicate) [Com P p ) Date Issued .__- <br />Application is hereby made to the San Joaquin Local Health District for a permit to c nstruct and install the work herein described. <br />This application is made in compliance with County Ordinance No. 549. <br />JOBADDRESS AND LO ATION-----/---------- /------------------ ---------------------------------------------------------------------------- <br />Owner's Name ------------- ------------------------------------- Phone `2 <br />Address - <br />Contractor's Name `----------------------- Phone -_X. <br />Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br />Number of Jiving units: __/-___ Number of bedrooms..._- Number of baths _/-___ Lot size <br />Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table-/11-G1ff.+ <br />Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe' Hardpan ❑ <br />Previous Application Made: Yes El No New Construction: Yes_[ No ❑ ` <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br />Septic Tank: <br />Disposal F/Id: <br />Seepage it: <br />Z <br />Cesspool: <br />El <br />Distance from nearest well ----------------- Distance from foundation ---------------- --- Material____________._______._._..._________..___ -______- <br />No. of compartments--- --- ------------------- Size -------------------------------- Liquid depth------- -------Capacity----------------------- <br />Distance from nearest well_________________ Distance from foundation -------------------- Distance to nearest lot line ____.--_-_--____. <br />Number of lines-------------------------- ------Length of each line ----------- ---------- --------- Width of trench ----------------------------------- <br />Type of filter material -------------------------Depth o 1 to )e: <br />-----------------Total length ------------------------------------------ <br />Distance to nearest well,lZ�/ Dist ce f m fo a- _ _ Distance to nearest lotline_____--Number of its----r--------------Linin mat ial----._-- ----Sio------_-De th- Q- _------p 9p <br />Distance from nearest well ----------------- Di <br />Size: Diameter --------------------------------- De <br />ante from foun ion __ -___--__-..__---.Lining material---------------- _-------------------- <br />------------------------------ -------------- Liquid Capacity ---------------------------- gals. <br />Privy: Distance from nearest well ---------------- .-------------------------------- Distance from nearest building _........_____________________._____.__._. <br />❑ Distance to nearest 'lot line-------------------------------------------------------------------------------------------------------------- ----- <br />Remodel in or repairing describe :__-__ _ 'f `G T'-, <br />------------ `---------------------------- - - -------------------:------------------------ -------------------------------------------------------------- <br />-- - - --s•'2--------------------------------------------------------------------------------------------------------------•------- -------------- <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, State laws, and rul ,s and recd ations of the San Joaquin Local Health District. <br />El <br />---- ---_-------- ------------------------------------ ----(Owner and ..or Contractor <br />By: _ {Title --- -- /'' <br />(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be p d on reverse s� <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY'---,,, ----------------------------------------------------------------------------------------- DATE --------------------------------------- <br />REVIEWEDBY ---------------------------------- ----------------------------------------------------------------------------------- DATE ---- ------------------------------------------------- <br />BUILDINGPERMIT ISSUED ---------------- - -------------- -------------------------------------------------------- DATE---- --- - -- ------ ------------------ <br />A,lt�ations and/or recommendations:- -- <br />-- - ��ldi1� - _" _-_. __ y'_-________. <br />1l.1.-.---- <br />-- -----� �-----°�'- 5 <br />-dam.• j------- �.-------- - - - - - -- �- - -------s';><-_�-------------- <br />---------- --------------------------------...--_--------- ----------------------------------------------------------- ---- -------- ------------------� - <br />----------------------------------------------------------------------------------r ---------------------------------------------------- - -1- ---------- <br />FINAL INSPECTION BY: �= G '= =="=J---------------- ------------- Date_------- <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 -9-2M Revised W-2100 <br />
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