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11553
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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11553
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Entry Properties
Last modified
10/24/2018 8:58:41 AM
Creation date
12/1/2017 12:02:30 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
11553
STREET_NUMBER
2382
STREET_NAME
WATERLOO
STREET_TYPE
RD
SITE_LOCATION
2382 WATERLOO RD
RECEIVED_DATE
12/21/1959
P_LOCATION
GEORGE BUTLER
Supplemental fields
FilePath
\MIGRATIONS\W\WATERLOO\2382\11553.PDF
QuestysFileName
11553
QuestysRecordID
1977327
QuestysRecordType
12
Tags
EHD - Public
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1 <br /> APPLICATION FOR SANITATION PERMIT Permit No. ___1.4._s Z` <br /> (Complete in Duplicate) ,1�,,a��..S <br /> This Permit Expires 1 Year From Date Issued Date Issued _g�794:7_ <br /> ' a <br /> Applicd+ion is hereby made to +he',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__ .a-rZ------ qT.E. _wo------F?b=k------------------------------------------------•---------------------------- <br /> �,.., a ....•, .,..� � . ... <br /> Owner's Name- Fo- ------------VOT�"- �' -------------------------------------------I- ---------------.--.---,----. Phone------------------- --- <br /> Address----------------------:...®....._... <br /> Contractor's Name------------------------------------------------------------------------------------------------------ -- `- -- Phone----------------------------------- <br /> Installation will serve: 'Reside'nce p Apartment House p Commercial Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of units: :_ Number of bedrooms -------- Number of baths _ Lot size _---------------------------------------------------------- <br /> Water Supply: Public system 17%,-1G`6munity system ❑ Private ❑ Depth to Water Table, ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: Yes [❑ No ❑ New Construction: Yes ❑ No ❑ ': FHA/VA: Yes ❑ -No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 1 , <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet. <br /> Septic T Distance from nearest well-WO------Distance from foundation___1a--------Materia€_._C'f1fl� <br /> No. of compartments........ Liquid depth---- __ ------------Capacity----__:900. <br /> Disposal .iefd: Distance from nearest well___—.'Distance from foundation-------------_-.Distance to nearest lot line___f�-_---_---- <br /> Number of lines___._'-------- --------------._.Length of each line------ -0--4,-____-Width of french----- ___.----__-_--- <br /> ""`"� " Type of filter ma erial-_-- Q�-�____Depth of filter material____ Total length-------------J ____________________• <br /> Seepage Pit: Distance to nearest well_:--_.----Distance from foundation__ __-_____.Distance to nearest lot line-----67.... Q s <br /> Number of pits_l____�-------------Lining material__+ _ _CA_____;Size: Diameter-_._-�3___--_..Depth--_-- _' _________________ <br /> Cesspool: Distance from nearest well-----------------Distance--from foundation--- j------------- Lining material--.-.----_-_-------------------------- <br /> ❑ Size: Diameter--�-----------------------------------Depth---------------------------------------------------Liquid Capacity----------------------------gals. <br /> l Privy: Distance from Iearest well-- ----------------------------------------------Distance from nearest building___-___._------_------_-_-------.--_.-. <br /> ❑ Distance to nearest lot line--------------------_.t ' - <br /> �. - ----------------=------------------------------------------------------------------------------------------=--- <br /> Remodeling and/or repairing {desciibeJ= ---- ----------- ---- --------------------------- ----------------------------------------------------------------------------------- <br /> i i <br /> -------------------------- <br /> i - <br /> --------------•------------------------------------------• ------------------------= <br /> I - <br /> --------------- ----------------------------------------------------------------.-.------------------------------------------------------------------------------------------------------------------------------ <br /> i I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> 1 ordinances, State laws, and rules and regulations of the San Joaquin'Local Health District. <br /> (Signed}- -Owner and/or Contractor) <br /> (Signed)-- <br /> By:------------------------------------------------------------------------------------------------------------------------------------{Title}-------------------- <br /> -- ----------------- <br /> ----------------------- <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 /> i <br /> APPLICATION ACCEPTED BY y DATE f� ----- <br /> -------------- <br /> REVIEWEDBY----------------------------------- ---------------------------------------------------------------------------------- DATE---------------------------- ---- <br /> BUILDINGPERMIT ISSUED-----------------------------------•----- -----=---------------- •---••-- -----• DATE-------•-------•----•---------------------------------------- <br /> Alterations and/or recommendations:-------------------------------------------------------------------------------------------------------------••----------------•---- ------------------------- <br /> j --------------------------------------- ------- 1t77 ------f--II-&P----r'-z=�---------------------------------------- <br /> i <br /> 4----I <br /> ----------------------- - ------ -- ---------•-------• ---------------- ---------------------------------------------------------- ---------------------------------- <br /> f /�.60. -. -.- <br /> � FINAL iNSP BY-_ - ---- - •- - 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 /> FS-9-2M Revised 8-'59 F.P.Co. <br />
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