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13797
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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13797
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Entry Properties
Last modified
11/16/2018 8:01:21 PM
Creation date
12/2/2017 12:46:55 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
13797
STREET_NUMBER
4744
Direction
E
STREET_NAME
THIRD
STREET_TYPE
ST
City
STOCKTON
SITE_LOCATION
4744 E THIRD ST
RECEIVED_DATE
01/05/1962
P_LOCATION
J LUMAN
Supplemental fields
FilePath
\MIGRATIONS\T\THIRD\4744\13797.PDF
QuestysFileName
13797
QuestysRecordID
1944878
QuestysRecordType
12
Tags
EHD - Public
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1 <br /> -------- -------- APPLICATION FOR SANITATION PERMIT Pefmit N€ ..._l _7 <br /> ----- ---- ----•-- ------------- <br /> (Complete in Duplicate) <br /> ------------------- <br /> ------------------- _ _„ This.Permit Expires 1-Year-From pate..lssued Date Issued __E:- G <br /> . <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 withCountyOrdinance No. 549. <br /> JOB ADDRESS AND LOC61JQN7- ---y- ,� <br /> *. •----- ---•----------••--------------------••---- ----- -----•----------------•----- ------------ <br /> _P Owner's Name_ -----•- <br /> Address---------------- 1-_7.t_ _ ... ---_. hone....... <br /> Contractor's Na'rne__.--•-----__-•--•- -,��-- -•- _ # -- <br /> ..-•------------------ <br /> •------ • - - •-- --------..._. Phone.-----•-----•-----• <br /> - • - -----••---•------•-• - ...----•-------- <br /> Installation will serve: Residence Apartment House ❑ ]Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: __ j__: ber of bedrooms' ❑ <br /> -f 1 r � Number of baths ...�_. Lot size .__.__.__��.,}�. <br /> Water Supply: Public system Community system ❑ -Private-El--Depth-to-Water-Table-5-7ft. } <br /> Character of'soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam Cla Loam Cla r <br /> Y ❑ Y ❑ y ❑ Adobe Hardpan ❑ <br /> Previous'Application Made: Ilf yes,date_____.______-------) No 0�New Construction: Yes No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ❑ p'NA: Yes ❑ No [ _ <br /> (No septic tank or cesspool permitted ifpublic sewer is available within 200 feet.) <br /> Septic ank: Distance from nearest well-� ----------- <br /> Distance frorim,foundation_____________-------Material__-____..___.._._,_.._._ <br /> No. of compartments- ---------- ---- Size <br /> --------------------------------Liquid depth------------- ---_-Capacityr <br /> Disposal Field: F Distance from nearest welL__i-``-_-----Distance from foundation.../0 L.___-Distance to nearest loline__-,5-1...,, <br /> S�` /1/ Number of lines-----------------f- ----"-------Length of each fine----- _T1--�-- <br /> _-- Width of trench-_-___-.�__ ----- <br /> ------ -.- <br /> Type of filter material.-_11a_�i1a_> - Depth of filter material__ .�-lt Total length______________�a••�_-___•• ------- <br /> - <br /> T -_.:z �.,P�rac4c-,.....�.s.-t_tea. -..-...= _f ,,.i <br /> Seepage it:, Distance to nearest well----.2r ---------Distance from foundation--./. <br /> U_--------..Distance to nearest lot line__o �____.._ <br /> Number of pits_..__ --------------Lining material.7ae: _____-"Size: Diameter__> � "� i <br /> �-� ------.-__.Depth__-_._ 7.5__.._-•-------••- V <br /> r r'r. - ' <br /> Cesspoo: Distance from nearest well_._:------4:4.Di�sta 1 e from foundation__________1._________Lining material-------------- <br /> El •__T _ _ --•------- <br /> ----•-Dep'lh_�------ ': � _ y ---• --•--•--Li uid Capacity <br /> ------ <br /> Privy: t Distance from nearest-well__' 1 <br /> q ----•-----------••---------.gals. <br /> Size: Diameter________:��,-• ' <br /> 4 -- -- --- building Distance to nearest lot line---- ' g `" "----•---------•-------------•--- <br /> ----------•-- ------- <br /> -------••------- --------•-------�---- <br /> Remodeling and/or repairing•(describe]:r_-_-"--tom- --_--_ k r <br /> s __ _ <br /> -- <br /> t.., <br /> ...... <br /> .----�..-.- ------•--- <br /> •--------------•-•-------------------------------•-•---------••== <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with Sen Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> [Signed)--------------••------- <br /> ---)- <br /> e <br /> .. . <br /> -----------0-5Z--- -------------(Owner and/or Contractorl <br /> By:•. ------" ........... : ..... L+syslem �` Title <br /> --------- <br /> .. = ( )--------Q rt <br /> (Plot plan, showing size of lot, loc i n of in relation to wells, buildings, etc., can be placed on reverse side). <br /> i <br /> FORFDEPAfVYENT USE ONLY <br /> APPLICATION ACCEPTED BY.___(_ __-_.__�_____- -�_ t <br /> REVIEWED BY.---- <br /> -••------- DATE 1 5 <br /> ------,I- <br /> --- -----------------•------------------------•---- <br /> BUILDING PERMIT ISSUED. DATE ---•----•--•--•-- ...---••--------• l <br /> .. ---------------------- DATE--- •--------------- <br /> AFFerations and/or recommendations:----------------•----=- --•------•---•-------------• <br /> • -----•-------------------------•------------------- <br /> ------•--:-------•-------------- <br /> ----------•--- <br /> FINAL INSPECTION BY----- ---------- ----•-----•---------- ------ Date------ = S~ = <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street <br /> 124 Sycamore Street 205 West 91h Street <br /> ES 9 REVISED g-59 zM 861 ATLAS <br /> Stockton,California Lod],California Manteca,California <br /> Tracy,California <br />
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