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22023
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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22023
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Entry Properties
Last modified
1/8/2019 10:09:47 PM
Creation date
12/2/2017 3:15:21 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
22023
STREET_NUMBER
4584
Direction
E
STREET_NAME
HARVEST
STREET_TYPE
RD
City
ACAMPO
APN
01703005
SITE_LOCATION
4584 E HARVEST RD
RECEIVED_DATE
6/30/1967
P_LOCATION
LOUIS ASCHWANDEN
Supplemental fields
FilePath
\MIGRATIONS\H\HARVEST\4584\22023.PDF
QuestysFileName
22023
QuestysRecordID
1747779
QuestysRecordType
12
Tags
EHD - Public
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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT Permit No. ._� <br /> ----------- --------- -- (Complete-in Duplicate) <br /> ...__.._. This Permit Expires 1 Year From Date Issued 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. 0(-7- 02 0-0-5 <br /> JOB ADDRESS AND LOATION///_0 - ------/,4,,_/..------ ------ ----- <br /> Owner's Name .!vir+- �. " � f/ ! --- - ---- ---- Phone___------------------••--- <br /> .... - <br /> Address r =' �" ./"�.!�! _. ... 1�. �� -Y ------ ------------------------------------------- <br /> Contractor s Name_l___r---- -7-pa-irtment <br /> �-- -------•-------- ----------- Phone---------•----------_---•-------- <br /> Installation will serve: Residence House ❑ Commercial ❑ Trailer Court p Motel ❑ Other ❑ <br /> Number of living units: Number of bedrooms __.___._ Number of baths-_1.-- Lot size -- -- .l- ------------------------------ <br /> Water Supply: Public system C1 Community system E] Private Depth to Water Table -7-6 ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam [ ] Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date------------------- ) 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.) k <br /> a Septic Tank: Distance from nearest well-----------------Distance from foundation-.------------------Material ----..---------------------------..-_____--_-_. 1 <br /> ❑ No. of compartments-------------------------Size-------------------- ------- ---Liquid depth--------- ....... ........Capacity----------------------- <br /> Disposal Field: Distance from nearest well.---------Distance from foundation-__�O----------Distance to nearest lot line__ ........ <br /> Number of lines.-----/--------------------------Length of each line._ .....;L_0_'._- ----.Width of trench...��.�----------------_._ <br /> Type of filter mate ria _ ------------Depth of filter mater�al_._._f_9..h -------Total length__19`4�-.0____________________________ <br /> Seepage Pit: Distance to nearest well...a-.V_---------Distance from foundation----3_Q_ ........Distance to nearest lot line__r!------ <br /> -- <br /> Number of pats.__ ..______________Lining material_ �'.-.� ___ Sae: Diameter---,3:3 .__..____Dept ______...___...-__. <br /> Cesspool: Distance from nearest well ----------------Distance from foundafiion----------------- _ Lining material__. ---- ---------------- � <br /> ❑ Size: Diameter. - - - -- --------- - ---Depth------ -------- --------- ------ ---------- ....--Liquid Capacity--- •---------------------..gals. <br /> Privy: Distance from nearest well _------------------------__-_--..-_._-........Distance from nearest building-.-----------------------------_.___-..._. <br /> ❑ Distance to nearest lot fine - ------- ------------- ---------------------------------- ---------------------------------------- <br /> Remodelingand/or repairing (describe):---- ---- ---------------------•-------------------------------------------------------------•----------- ---------------------------------•------------ <br /> ---•--------------••---•-------------------------•----------------------------- ------------------------------ ----------------------------------------------- ----- -----------------------•---------------------------- <br /> -------- -------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------•-------•-------------------------------- <br /> ---------- <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, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)-, ----- ----- (Owner and/or Contractor) <br /> -_=-�'— --- - ------ ---- ------(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 , --------------------------- ______ DATE----- '3 ` -7 <br /> ---------------- <br /> ----------- <br /> REVIEWEDBY--------------------------------------------- -------------------------------------------------------------- --------- ------ DATE <br /> BUILDINGPERMIT ISSUED-------- -- - ----------------------- ---------- --------------- ---------- ------- --- ---------- DATE------------------------------ ------------------------------ <br /> Alterations and/or recommendations:----------------- -------------------------- ---- -.-•-•---------------------------------------L------- ---------------- ---------------- <br /> ---------------------------•-------...-----------------------------------.....-------------- -------------------------------------- <br /> -- -------------------------------------I------------- ------------.._.. ------------- ----------- ---- -------------------------- <br /> FINAL INSPECTION BY: /" . :------------ Date-_ - - -_--�� ---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazellon Ave. 300 West Oak Street 120 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi. California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />
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