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4200/4300 - Liquid Waste/Water Well Permits
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17681
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Entry Properties
Last modified
12/17/2018 10:11:05 PM
Creation date
12/1/2017 7:33:07 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
17681
STREET_NUMBER
2740
STREET_NAME
ROOSEVELT
STREET_TYPE
ST
City
STOCKTON
SITE_LOCATION
2740 ROOSEVELT ST
RECEIVED_DATE
07/16/1964
P_LOCATION
JOHN KATEZ
Supplemental fields
FilePath
\MIGRATIONS\R\ROOSEVELT\2740\17681.PDF
QuestysFileName
17681
QuestysRecordID
1912076
QuestysRecordType
12
Tags
EHD - Public
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F)OR OFFICE USE: <br /> 7,- <br /> '71, l <br /> --------------- ------ ------------•--------- <br /> _ 71-4-4..-_• _ _�1.p_ APPLICATION rOR,SANITATION PERMIT Permit No. 11.6---0 <br /> (Complete in Duplicate) ,,,4 <br /> - - Date Issued '211-4110_ <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 described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> : <br /> JOB ADDRESS ND L CATION -- ----���-�------ -t'��1-�:�! - --------- &71��-�------------------------------- ---------- <br /> !1: . , w .Phone-- ----- <br /> Owner's Name `'' F ._. - <br /> I <br /> Contractor's aAddress <br /> me----- - do--•--- -- i(�1--- -----� ��J�.�----- Pone <br /> ,. +� <br /> Installation will serve: Residence Aparrtment House ❑ Commercial ,❑ Trailer Court ❑ (Motel ❑ Other ❑ <br /> Number of living units __�___._ Number of bedroom st'� -_ Number of baths ----____ Lot size _______-9__ _-J�___----_��__0_________________ <br /> I <br /> Water Supply: Public`syste Community system ❑ Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth 3 #eet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: 1�(If yes,date--------------------I No© New Construction: Ye))e] No ❑ FHA/VA: Yes E] _No ❑ <br /> f <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 204 feet.) aw, <br /> . M t .rial__----E�-� __�% _ctrY1 <br /> tic Tank: <br /> Distance nearest well-- '"_____Distance f pm foyn �on__- O -___- <br /> No. of compartments_______ ________ `r __Liquid de . - --> _ .__. <br /> �� Size. . q Capacify.. 0 / <br /> osal Field: DistancJl rom nearest well_______ _________Distance from found f, n___ _ ___._._.Distance to nearest lot !ne ---_,__ <br /> ---- <br /> Number lines________ __ ___ __________Length of each line_____ _ <br /> ` / r -_----.Width of trench--- -- - p<<-��_ _r__'_- <br /> Type of:filter material �ti_______.Depth of filter material____________________Total length----- S`_��_______________________-._ <br /> -,.:ice / - -a f ,�, .�. <br /> page-Pit: Distance,to nearest well__________ __________Distance f m undation_._1f._.___.:-.___.Distance'to nearest I t iine.-_:c�_____-_._ <br /> - ----- A. t �'-1 <br /> Number�of Pits -------------Lining material- -�f-_!tom' Size: Diameter-__��-/� .Depth_. _..-��-_-�µ�_,--.-_._� � <br /> Cesspool: Distance:,fi•om nearest well____-Y:=___.---Distance from fount€anon.-._"_ _____________Lining material----- ----_:---- <br /> f;rg=-------------- � <br /> Size: Di'lmeter------------------------------------De th----------------------------------------------------L't uid Ca aci als. <br /> El 9 p tY - 9 <br /> Privy: Distancl from nearest well-----------------_____-------------------------__Distance from nearest building__-_-______________________________..__._- <br /> ❑ Distance. to nearest lot line------ ---------------•--------------------------•------•----•- ... --------•-•--------------------- -------------------------------- <br /> Remodeling and/or repairing (describe):--------------------------- --= 0 <br /> --•---------------------------------------------1I---------- ---- ------------------------------------------ <br /> --------II----------------------•-•---------------------------------------------=------------•---•------••-------------------------------------------------------------------------� <br /> ------------------------------------- ---------- ---------------- '---------------------- - C <br /> I hereby certify that I Hlaye prepared this application and that the work will.be done in accordance with San Joaquin County <br /> ordinances, State laws, and `rules and regulations of the San Joaquin Local Health District. <br /> (Signed) ! Owner and/or Contractor <br /> E A.1 ----Title <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.,.can be placed on reverse side). - <br /> i!li <br /> �I FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED'iBY-- -- ---------------------------------------- DATE------ <br /> '-•----------------- <br /> REVIEWED BY----------------- DATE <br /> �' - --- ---------------- --------------------------------- ------------- <br /> kBUILDING PERMIT ISSUEDAI---------------------------------------------------- ------------------------------------- DATE---------------.------------------------------=------------- <br /> f Alterations and/or recommeations:---:-- - . - ---- . . --- <br /> n <br /> 5nc-"__ Jz r✓���--------------------- -- - --------------------------- ---- <br /> I --------- - <br /> ------ ---------------------------------- --------------------------------- ----------------------•-••-----•-••- -------------------------- ---------- <br /> ------------------------------------ <br /> --------------------------- <br /> II <br /> ------------------•--------------------`--------------------------------------------------- -----------•-•---•---------------------------=•----- --------------------------------------- ----------------------------- <br /> FINAL <br /> ----------------------------FINAL INSPECTION TION BY: e_rwDate Date . <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street - 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 R£V15ED 8-59 3M 3-'63 F.P.CO. <br />: II <br />
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