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4200/4300 - Liquid Waste/Water Well Permits
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2325
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Entry Properties
Last modified
1/12/2019 10:05:38 PM
Creation date
12/2/2017 8:19:24 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
2325
STREET_NUMBER
5238
STREET_NAME
LAFAYETTE
STREET_TYPE
STREET
SITE_LOCATION
5238 E LAFAYETTE
RECEIVED_DATE
03/12/1952
P_LOCATION
ORVILLE M GASTON
Supplemental fields
FilePath
\MIGRATIONS\L\LAFAYETTE\5238\2325.PDF
QuestysFileName
2325
QuestysRecordID
1812933
QuestysRecordType
12
Tags
EHD - Public
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APPLICATION FOR SANITATION PERMIT Permit No. pc _o2_._.. <br /> (Complete in Duplicate) <br /> 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. <br /> JOB ADDRESS AND LOCATION---._._.___----- _______________------ '3 - "`'' <br /> Owner's Name..------ .......... = ------------------ ----------------------------------------- Phone.....Z r ------ <br /> Address-----------------------------•- ------------------------------ <br /> Contractor's Name-------------------------•-••------------------------------------•--------------------------------------------------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence 1�, Aparfinent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: J______ Number of bedrooms -g--- Number of baths --/___ Lot size -------f_O-Q---x__a___Z1----------------------- <br /> Water Supply: Public system Community system C1 Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe LZ Hardpan ❑ <br /> Previous Application Made: Yes ❑ No E�r New Construction: Yes ❑ No EK <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well __-00------Distance from foundation___--Z:�_�___ _____.Material_________________ ______ ------ <br /> No. of compartments-------� _._---------Size----'3-X-r--X--- ----Liquid depth------_'`/------- ------Capacity—.471•-•---�Q--C. <br /> Disposal Field: Distance from nearest well----- --------Distance from foundation---I�----------Distance to nearest lot Ilne__E-_ ________ <br /> Number of lines --------- <br /> Length of each line-----------Na'----_-____Width of french-------��--------------------- <br /> Type of filter material_I/�-9'.� Depth of filter material_______�_�"_i__----.-Total length___._._____ <br /> ----- —�- <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----------------------------gal <br /> Privy: Distance from nearest well__________ ______________-_-__-_-__--_---_Distance from nearest building------------------------------------------ <br /> 0 Distance to nearest lot line---------------------------------- --------------`-------�--------------------------------------------------- ------------- ------------ <br /> Remodeling and/or repairing (describe):--------r. - -- -�------- "�� '� --••-----• ------------------------------------- <br /> ----------------------------- <br /> ------ <br /> -------------•-------------•--•--------.:X41. f ------£C h�4 n..c�`.0-0-----------� �'` =-------------------------------------- <br /> --- <br /> /' �1 <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) /11 t ___. - ______________________---_Owner and/or Contractor <br /> BY:------------------------------------------------------------------------------------------------------------------------------------(Title)--------------------------------------------------------------- <br /> (Piot 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 BY-------------- ----- ------- -- ---------------------------------------- DATE-------- --- <br /> REVIEWED BY--------------------------------- ---------- ------------------------------------ <br /> ------------------------------------------- DATE----------------------------------------- <br /> ------------------ <br /> BUILDINGPERMIT ISSUED------------------ -------------------------------------------------------------------- ---- DATE------------------------------------------------------------ <br /> Alterationsand/or recommendations:-----------------------------------------------------------------------------------------------------•-------------- ---------------------------------------- <br /> ---------------------- ------------------------------------------------------------ --- ----------------------------------------------------------------------------------------------------------------------- <br /> --- ------------------------------------------------------------------------ --------------- <br /> FINAL INSPECTION BY: -y---__ ------------------ ------------- Date `3/--------/------------2----,--------- <br /> --- -----'--------------------------------------- <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 /> ES-9-2M 8-51 Revised W-2100 <br />
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