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16789
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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16789
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Entry Properties
Last modified
12/8/2018 10:30:51 PM
Creation date
12/1/2017 9:03:51 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
16789
STREET_NAME
SHELTON
STREET_TYPE
RD
SITE_LOCATION
SHELTON RD BARNETT RANCH BALOTA
RECEIVED_DATE
01/09/1964
P_LOCATION
EMIT POWERS
Supplemental fields
FilePath
\MIGRATIONS\S\SHELTON\0\16789.PDF
QuestysFileName
16789
QuestysRecordID
1923213
QuestysRecordType
12
Tags
EHD - Public
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l rUK UN-K-t USE: <br /> - APPLICATION`OR SANITATION PERMIT P 6 r <br /> _ Permit No. __-l..._.--74" <br /> - -- (Camplete in Duplicate) <br /> Issued e a <br /> From This Permit Ex fres I Year FroDate I / <br /> - bate 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 /> JOB ADDRESS AND LOCATION--- - <br /> l - <br /> Owner's Name - <br /> Address <br /> ------ Phone__ <br /> -- -•-•--••- ---------------------- ------ <br /> Contractor's Name--------- ---------------- - o <br /> r t ---- ---- Phone-A.41_56i.k C <br /> Installation will serve: -Residence &-Apartment House ❑ Commercial <br /> r•' ❑ Trailer Court ❑ Motel ❑ Other ❑ ' <br /> '" Number of living units: Number of bedrooms Z-'Number of baths -__j_._ Lot.size ____________________ <br /> Water Supply: Public aystem ❑ Community system ❑ Private <br /> 11. [ ` Depth to Water Table _b''S__`ft. <br /> t <br /> Character of soil to a depth of 3 feet:, Sand ❑ Gravel [] 1Sandy Loam [�''Clay.Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,dlate.___.._______..__._1 No <br /> []-� New Construction: Yes Rt 10 ❑ FHA/VA: Yes 0 No ❑ <br /> -.-.-.TYP.E-OF INSTALLATION-AN D_.SPEC IFICAT.IONS:� ' <br /> (No septic tank or cesspool permitted !f public sewer rs available within 200 fee{,) <br /> Septic Tank: Distance from nearest well___.f_-b__ ___Distance from foundation_ ._1A __ _ <br /> No. of compartments--------- - <br /> ------ Li uid de th_ ... <br /> Wt <br /> q ` <br /> -- p <br /> -------Capacity_' - <br /> Disposal Field: Distance from nearest well--�,z._A_.*,_._Disfanfc`eexfrom foundation__, p._/�__r___.___.pistance to nearest lot line. <br /> __.. <br /> Number of lines-----------J_--_-•--------_ ---Lengt9 of each line---------55t_4! =----.Width of trench.-----Z.--' <br /> r P ��. ----------------- <br /> Type of filter materialh�t? C---__,De th of filter material____!Ar----------- length-----------51_tl--__ <br /> Seepage Pit: Distance to nearest�well__/.40 0---------Distance from <br /> _ foundation_.Number of pits-----w1_ Dist�a/nce to nearest lot line�_S__r. <br /> _____ <br /> -__.___.__ nng.material- Size: Diamefie <br /> ----- Depth-._._�,;r .{ <br /> Cesspool: Distance from nea est well_________________ <br /> Distance from foundation..____-------[___.Lining material___.__------- --. / <br /> ❑ Size: Diameter------ ------Depth------- ---- ------------ --- !----Liquid Capacity-- gals. ' <br /> ----- <br /> Priv 6 <br /> ❑ Distance to nearestflot line------------------------------------- Barest building----------------------- <br /> y� istance.from nearest well_ -___________________ <br /> i -------------------------- <br /> Remodeling and/or repairing (describe)--------=--------- ___---------- <br /> -----•------------------------- -------------------------------------------------------- <br /> = - ------------------------------------------------ I: <br /> I`I v. -------------------- <br /> - -= --------------------------=--------------------------------- ------ .. <br /> Le' w R <br /> ------------- ----------------------------------------------------- ---------------�--• ------------------------------------------------- <br /> ! herebycertify that I have r - � - <br /> Y prepared this application and that the work will be done;in accordance with San Joaquin County <br /> ordinances, State laws,.a rules and Agulati.ons of the San Joaquin Local Health District. <br /> (Signed)------------ t <br /> F <br /> _. 3 <br /> -�- - � � .((Owner and/or Con+ract <br /> r <br /> --------- <br /> {Titled --- --------------- ___ ------ <br /> By: <br /> ---------------------------------- <br /> (Plot plan, showing size of lot, location o;f system in relation to wells, buildings, etc., can"be placed on reverse side). - + <br /> FOR DEPARTMENT USE O Y <br /> APPLICATION ACCEPTED BY ^� <br /> ' DATE--------- <br /> -------------------- r------ <br /> -------------------------------- <br /> REVIEWED BY ------------------------------------ <br /> 1 <br /> ---------------- ---------------- <br /> DATE <br /> UILDING PERMIT ISSUED----------------- <br /> ------------------------------- - <br /> --------------------------------------------- ------------ ------ DAT.E. <br /> Alterations and/or,recommendations:------_.__._ _ -- ....... ......... .. <br /> ----- <br /> --------------- <br /> ---•-------- •----------------------------------------------------------- -- --------------------------------------- <br /> -------------------- ----------- --------- --------- ---------------i <br /> ----------------------•-----•----•-----•-------------------------------------------------------- <br /> --------------- -- <br /> -- -- -- - ------------------- <br /> FINAL INSPECTION BY:__._ <br /> s Date. =,� f <br /> ------------------------------------ <br /> SAN.JOAQUIN LOCANEALTH DISTRICT <br /> 1601 E.Hoselton Ave. '300 West oak Street <br /> 124 Sycamore Street 205 West 4th Street <br /> Stockton,California Lodi,California Manteca,California "" "A `� <br /> Tracy,California <br /> ES 9 REVIS Eb 8-59 3M 3-•63 F.p,CO, _ <br />
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