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14955
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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14955
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Entry Properties
Last modified
11/27/2018 4:51:22 AM
Creation date
12/2/2017 2:28:02 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
14955
STREET_NAME
HARLAN
STREET_TYPE
RD
City
LATHROP
SITE_LOCATION
HARLAN RD HWY 50 1/4 MI NO OF LOUISE AVE
RECEIVED_DATE
10/25/1962
P_LOCATION
LIBBEY OWENS FORD GLASS PLANT
Supplemental fields
FilePath
\MIGRATIONS\H\HARLAN\0\14955.PDF
QuestysFileName
14955
QuestysRecordID
1743501
QuestysRecordType
12
Tags
EHD - Public
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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> -------------------------------------------------------- <br /> ..1 ,1- --•-••- <br /> -------------------------------------------------- <br /> (Complete in Duplicate) <br /> Date Issued _-..-_-_...�j.•�_._�� <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 compliarice with County Ordinance No. 549. �aJ 7 <br /> JOB ADDRESS ANLOCATION----- ------ --�--- -- � - - <br /> nn �+ <br /> Owner's Name__._ `` 1'; /��- d/ [�f� �1 N Phone <br /> -if <br /> Address - ] ------ eZ �1 � <br /> Contractor's Name...---------� a Phone.......... <br /> Installation will serve: Residence, ❑ tot rt 0 ❑ ❑ ' <br /> ' Apartment House Commercial Trailer Court Mote! Othari <br /> Number of living units: ____--- Number of bedroom_- Number of baths .__-... < <br /> Water Supply: Public system ❑ Community system ❑ Private �epth To Water Table <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam El Clay Loam ❑ Clay I–] Adobe❑ Hardpan ❑ <br /> Previous Application Made- (if yes,date--------------_----l No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet) ... • 1 . <br /> Septic Tank: Distance from nearest well-----------------Disfance`from four-dation--------------------Material-------_----------------------------------------- • � <br /> A Z( +! N No. of compartments----- ------------------ -Size--------------------------------Liquid depth__---------------------Capacity <br /> Disposal Field! Distance from nearest well------ P_j--_Distance from foundation---la.'.......Distance to nearest lot line.:A.._.e . <br /> {–! N Number of lines----------••---�- ----------------Length of each=line---- -------------.....Width of trench.-_ _��..�.----...---_-...` <br /> Type of filter material._ J__Z_x� -"Depth of filter material-----)_�... .......Total length---------7x7___-----________________ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line..--------------- <br /> ❑ Number of pits----------------------Lining material-------=---------------Size: Diameter-----------------------Depth <br /> Cesspool. Distance from nearest well-----_-----------Distance from foundation---.--------.-------Lining material..__.._____.-__-___.....________--.._ <br /> Size: Diameter------------ -------------------------Depth---------------------------------------------------.Liquid Capacity------------•-•-----------..gals. <br /> Privy: Distance from nearest well---------------_____________________0.`____._.._Distance from nearest building.____.________-._________".-____..____._. <br /> ❑ Distance to nearest lot <br /> I a <br /> line------------- E-p--i-.-�--- --------- ---- <br /> - -�_..=---------.._ ------- ----------•---._... ----•---•------- -------- <br /> Remodeling and/or repairing (describe):------------------------xift <br /> ------ <br /> i -----•-•---"-••------------------------------------------------------ ------- ---- •----.-----------------. <br /> ------------ ----- ---- - <br /> IQ.�zSr .,� �-ra i► C _VFp - n <br /> ---------13V . <br /> _____ ----------------------------•---------------- <br /> 1 hereby certify that I have 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 /> �R <br /> (Signed).. fa <br /> - ,---i--------- -------- - -- `_- --------------------- (Owner and/or Contractor) <br /> By:------------_•--- ---------- ---- (Title)---- ----- --- --- - ---------------- <br /> [Plot plan, showing sire of to , to ation of system in relation to wir, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> --------- ----------------------------- U DATE------- -0------�.�---�a---- �--------•-------------- <br /> APPLICATION ACCEPTED BY_____________________ - <br /> REVIEWEDBY------------------------- - --------- --•------------------ - DATE----------------------------------------------------- <br /> BUILDINGPERMIT ISSUED----------------------- --- ----- ---------------------------------------- DATE----------.------------------- --•-----•--------------------- <br /> Alterations and/or recommendations----------------------------------------- ------•"------•-•--------------------....--•-••-"---••----•----------•---- •-------------•----------••- <br /> ! ---------------------------------------------------------------------------------------- <br /> FINAL INSPEC - - - - - - •- ----- - -------- --- - -- <br /> --- Date......__ /a. �� `� ��r------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Strut 300 West Ook Rreet 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,Callfomia Tracy,California <br /> ES 9 REVISED 8-59 2M 5.62 ATLAS <br />
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