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78-200
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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WATERLOO
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7255
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4200/4300 - Liquid Waste/Water Well Permits
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78-200
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Entry Properties
Last modified
6/8/2019 10:20:25 PM
Creation date
12/1/2017 12:12:47 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
78-200
STREET_NUMBER
7255
STREET_NAME
WATERLOO
STREET_TYPE
RD
City
STOCKTON
SITE_LOCATION
7255 WATERLOO RD
RECEIVED_DATE
04/11/1978
P_LOCATION
RONDEL ROCKEY
Supplemental fields
FilePath
\MIGRATIONS\W\WATERLOO\7255\78-200.PDF
QuestysFileName
78-200
QuestysRecordID
1978769
QuestysRecordType
12
Tags
EHD - Public
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FOR OFFICE USE; FOR OFFICE USE: <br /> ---------- ................... _.. <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No.?.-_�. ... <br /> Date Issued- ��_�. <br /> ---•--•-------- --- ........-----........--....... This Permit Expires 1 Year From bate 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 Ordin nce No549 and existin Rules and Regulations; . <br /> � <br /> r <br /> JOB ADDRESS/LOCATION...---`-.- - .- - .. .._� - ---------------------.CENSUS TRACT_—.... -------- <br /> Owner's Name...-..... .. Phone.---....-----................... <br /> Address---------- -- - - Cit -Zi <br /> Phone--- 1 / <br /> Contractor's Name---- License # i�� �� � , <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ i <br /> Motel ❑ Other------------ -- ------------ ---------- <br /> Number of living units:................Number of bedrooms........._.Garbage Grinder--------.---Lot Size..-------....:....... - - -----------_------- <br /> Water <br /> -.-------- .----Water Supply: Public System and name-- --------------- --------- ------------------------ --- ----• --• ------ ------ --------------------- - --------------------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe ❑ Fill Material.. .... ....If yes, type----------------------------- <br /> --- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.) ' <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,] <br /> PACKAGE TREATMENT [ ] SEPTIC TANK [ l Size --------------- -------------- -------------Liquid Depth_..:--.--- 'J <br /> Capacity-- -w-----------TYPe--•............. ......Material--------------------------No. Compartments............... -------------- N, <br /> _ <br /> Distance to nearest: Well--------------------- -- --- --------------Foundation------.... ....... Prop. Line........-..... ------------VI <br /> LEACHING LINE [ ] No. of Lines -------------------------- Length of each line........---...-....-......._._ Total Length ... -__..- __ <br /> 'D' Box_...........Type Filter Material-_._ .....Depth Filter Material-- .- ----------------------------------------------- -----. <br /> Distance to nearest: Well--------------------------- Foundation------.-.--------------.--.-Property Line.----------...-.................... <br /> . <br /> SEEPAGE PIT [ ] Depth.-.............-Diameter--------------- ....Number-------------------------------- Rock Filled Yes ❑ No ❑ <br /> Water Table Depth---------------- ---------- - - -- ------- --------------Rock Size.........__------- -------- _---• ---------- <br /> Distance to nearest: Well--------------- ---------------------------Foundation -..Prop. Line------.----------- .-------. <br /> REPAIR/ADDITION (Prev. Sanitation Permit#--------------------------------- ---------------Date------------------------------------..--.------] <br /> Septic Tank (Specify Requirements).............. ------... --- r -------------- --------- --------- <br /> -- r- <br /> Disposal Field (Specify Requirements] - --- -� �j ----•� t�j -------------------------------------- <br /> {Draw existing and required addition on reverse side] <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, Home owner or licensed agen#s <br /> signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such spanner as <br /> to become subject to Workman's Compensation laws of California." <br /> Signed....--- _... ........ ..... ......----....Owner <br /> Title <br /> (If other than owner] i <br /> FOR EPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----..... - . _ -- DATE ..-.... . ...... - - <br /> DIVISiON OF LAND NUMBER .. --- ------------..-....DATE............... --- ---------.- - -- ----------- <br /> ADDITIONAL <br /> ---- -ADDITIONAL COMMENTS................ ........ --------------- ------------- - --- --- <br /> ----- ---------------------------------- ------------------ -- - ............ ---------------- -------------------.-----------............................. <br /> --•---------------------- -------------------- -- ---- <br /> Final Insgect�on b -.. <br /> Date. ' <br /> Y' --- ------- <br /> Eli 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fes 21677 REV. 7176 3m <br />
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