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19627
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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1447
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4200/4300 - Liquid Waste/Water Well Permits
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19627
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Entry Properties
Last modified
12/26/2018 10:13:56 PM
Creation date
12/1/2017 6:47:17 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
19627
STREET_NUMBER
1447
STREET_NAME
REPORT
City
STOCKTON
SITE_LOCATION
1447 REPORT
RECEIVED_DATE
10/01/1965
P_LOCATION
PEDRO CISNEROS
Supplemental fields
FilePath
\MIGRATIONS\R\REPORT\1447\19627.PDF
QuestysFileName
19627
QuestysRecordID
1907591
QuestysRecordType
12
Tags
EHD - Public
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=0111C USE: <br /> '^'" i Permit No." �p;3a "" APPLICATION FOR SAWATION PERMIT-- ----------- ------- (Complete in Duplicate) Date Issued <br /> This Permit Expires 1 Year From Date Issued r <br /> Application is hereby made to the San Joaquin LocaOrdinance aghDlNoG f or a permit to construct and install the work herein described. <br /> This application is made in compliance with County 9. <br /> i� <br /> l\_ ��ni •------------------------- ---•---•----- -----------•- ----------------------- <br /> JOB ADDRESS AND �QCATION Phone-4a-_4 �"------ <br /> --------------- <br /> Owner's Name <br /> Address-------- on <br /> Contractor's Name________________ ___ _ qMotel Other [IInstallation will serve: Residence 0---Apartment House E] Commercial ❑ Trailer Court ❑ ❑ <br /> --- "-- Number of baths __%--- Lot size ----�+.�--�--?��--•-----------•---•-"" --- <br /> Number of living units: ___�__ Number of bedrooms - � ------ <br /> Depth to Water Table __..____ ft. <br /> F Water Supply: Public system D�Community system ❑ Private ❑ p <br /> Character of soil to a depth of 3 feet: Sand [I Gravel ❑ Sandy Loam ❑ Clay Loam ❑"Clay ❑ Adobe❑ Hardpan C] <br /> 1 - No FHA/VA: Yes E] No p- <br /> Previous Application Made: (If yes,date----------- --- -I No ❑' i i Construction:� Yes R ❑ <br /> I. TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation_-------�e th-"Material_-------- Capacity------------------- <br /> No. <br /> _____.. ____ __. <br /> ❑ No. of compar#menu--------------------- ----Size- --------------- ---------=- q p <br /> Ilk <br /> I Disp sal Field: Distance from nearest well-._-._.--"-=Distance from foundation__ Q-------- Distance to nearest lot lirle�_^a <br /> f -Length of each line-_-_ Width of trench..._..-��---------- <br /> ❑�_ ber of lines % 9 <br /> Type er filter material__-3��-c°�°1E�---Depth of filter material-_-� ------------Total length--.--__ '_� ----- <br /> Num \ <br /> ' _ Distance to nearest lot line- ----• �( <br /> Seepage�P•st: Distance to nearest well------ -----------Distance fr foundation.__a� _-- <br /> ® Number of pits------/------------Lining material-_-/ Size: Diameter__. %. ---- ---Depth._-_r '. -- <br /> f <br /> Cesspoo$: <br /> Distance from nearest well-----------------D'sstance from foundation------------ -'---- nmaterial <br /> ------ - ------- -----gals. <br /> --Depth------- --------- -------- -------- --------------- Liquid Capacity y--------------------------- <br /> ❑ Size: Diameter___-------------------- ------ - <br /> Distance from nearest building___ -—----------------------- ------- <br /> Privy: Distance from.nearest well -_ ;;.__ _ r_ �..... .... ------------------------------- <br /> pistance to nearest lot lire.-------.-------- <br /> ----- ------------ <br /> ..�,. <br /> - <br /> - <br /> I <br /> Remodeling and/or repairing .(describe):--- - --- -- 1-._ <br /> ------------------------- <br /> __ ------------- <br /> ------------------------------------------------------------ <br /> I P <br /> j - ----- - -- --------------------------------------------- -- -- -- <br /> hereby certify that I have prepared+his pplicattion and that the work will be donein:accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations oof he San Joaquin Local Health District. <br /> 7fwn fan d/or Contractor) <br /> Si ned -- ------ ---------- <br /> ------------------------------( 9 ] <br /> •`- ��Q�__�t.rx--.--�_�--------------- (Title)-- -- ------ -- <br /> BY'-------------- F v / <br /> (Plot plan, showing size cf la location of syr}em in relation'to wells, ; uildings, etc., can be placed on reverse side]. <br /> FOR DEPARTMENT)USE ONLY I <br /> I � <br /> DATE------ __� -f. ------------------ <br /> APPLICATION ACCEPTED BY--- ------ --- - <br /> ----------- DATE-------- ------------------------------------------------- <br /> REVIEWED <br /> ----------------- ------------------------ <br /> REVIEWEDBY---------------------------------- --------- ---------------------------------- ---------------------- DATE---------------------------------------- -------------------- <br /> BUILDING PERMIT ISSUE ------------------- --- -------- - --- -- -----`-"---- G , <br /> Alterations and/or recommendations:------�!' - ------------ ---------__--- <br /> _-. - <br /> ---------- <br /> ----------------- <br /> ------- ------- <br /> --- -- li t < <br /> ---------------- = ------ ----------- --------- ---------------------- ----------------------------- <br /> � ox -------------------------------------- <br /> FINAL <br /> -- --- ---- ------ - <br /> FINAL INSPECTION BY--------- ----- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haseltan Ave. 300 West Oak Street <br /> 124 Sycamore Street 205 West 9th Street <br /> Lodi,California <br /> Manteca,California Tracy,California <br /> Stockton,California <br />
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