My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
5349
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
T
>
TAFT
>
817
>
4200/4300 - Liquid Waste/Water Well Permits
>
5349
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
1/28/2019 12:24:27 AM
Creation date
12/2/2017 12:27:42 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
5349
STREET_NUMBER
817
STREET_NAME
TAFT
STREET_TYPE
AVE
City
STOCKTON
SITE_LOCATION
817 TAFT AVE
P_LOCATION
NW ROBERTSON
Supplemental fields
FilePath
\MIGRATIONS\T\TAFT\817\5349.PDF
QuestysFileName
5349
QuestysRecordID
1942760
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
View images
View plain text
APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) '{ <br /> Date Issued <br /> Applic&ion is hereby made to the San Joaquin Local Health District for e permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. 1 <br /> JOB ADDRESS AND LLOOjCA�T}I��N------- �- ------ - ------ ---------- .' ..---------------------------------------------------- ----------------------------------,----5-------3------------ <br /> f�E' - Phon .3---?f.- <br /> Owner's Name---------- -----"t---- - - ....... ---- <br /> 7 .. <br /> Address- ,// -- - -- -9'l- - - —� ------------ <br /> ----- <br /> Confractor's Name-----=�--- -----------.----------- -- -------•------------------------------------------•----------------------- Phon ---. a-< <br /> Installation will serve: -Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: --- "" Number of bedrooms .crn _i _ <br /> / _ <br /> ,_ Number of baths __1___ Lot size __sQ� ._____, d ____________ --_____ _____-_ <br /> Water Supply: Public system �mmunity system ❑ Private ❑ Depth to Water Table ._Xl ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam[] Clay ❑ Adobe 2--`Hardpan ❑ <br /> Previous Application Made: Yes ❑ No Eft New Consyucio : Yes �o <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ' <br /> (No septic tank or cesspool permitted if public sewailable within 200 feet.) <br /> Septic 'nk: Distance from nearest well----- Distance from gundato n__��__________.Material_ <br /> No. of compartments------- --------- _--- P. p y----------- <br /> _-"""-"_Size_ �s�_�Liquid de th__.______-�.-.. " -. Ca acit � "-- <br /> Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line_____?_.-__----- <br /> ❑ Number of lines-----:--- `-----.--"L'engfH'of.eaE5ine------------------------------Width of trench------------------------_---------- <br /> Type of filter material-________________________Depth of filter material--------.---------.____Total length___________________________-_._____�____ <br /> Seepag it: Distance to nearest well"'_:" -----___Distance fro fou dation___�_d-_,td -.Dista Distance to nearest lot liner_______ <br /> Number of pits------I..._________Lining material_��_C�� _.Size: Diameter__ .14 — <br /> Vr ___________.. - <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-__________._____________-_-______--- -A <br /> E] Size: Diameter----------------------------------------------------------------Depth- ------------------------------ ------------ Liquid Capacity-----------------------------gals. <br /> Privy- Distance from rearest well_______________________________________________Distance from nearest building_____________--_------.-....__.__..______- <br /> ❑ .� <br /> --•Distance to nearest lot line-------------------------- - ------------•-------------------------- - -------------------•--------=-=----------------------- - <br /> Remodeling and/or repairing (describe]:__ r ----- --- '---------------------------------------------a---------- <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, Sta aws, and rules and regal ions of the San Joaquin Local Health District. <br /> ---- <br /> (Signed, and/or Contractor) <br /> ------ _ --- ----- ---- <br /> BY= --- ------_---- ----------=----------------------------------------------•--- (Title) <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -- - ------- R DATE <br /> ---- �------ . --- <br /> REVIEWED BY----------- ------- <br /> ------__r - --------------- ------ --- --------------•----------------- DATE <br /> BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------- DATE----------------------------------------------------•-•=----- <br /> Alterationsand/or recommendations------------------------------------------------------------------------------------------------------------•----•...................... •--------------- _---- <br /> ------------------------------- -----------------------------------------------------------------"------------------ <br /> -----------------------------------• ---------------- ----------------------------------------------------------------------------------- <br /> -------------------------------- - - ------------------------------ ------ -T--------------------- ----------- --------------------------------------------------------------------------I----------------------------------- <br /> FINAL INSPECTION -BY:---------- V.- �� �?i'------ 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 /> E5-9-2M Revised W-2100 <br />
The URL can be used to link to this page
Your browser does not support the video tag.
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).