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74-943
EnvironmentalHealth
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LOCUST TREE
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4200/4300 - Liquid Waste/Water Well Permits
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74-943
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Entry Properties
Last modified
4/20/2019 10:05:07 PM
Creation date
12/2/2017 10:17:22 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
74-943
STREET_NUMBER
14564
Direction
N
STREET_NAME
LOCUST TREE
STREET_TYPE
RD
City
LODI
SITE_LOCATION
14564 N LOCUST TREE RD
RECEIVED_DATE
10/10/1974
P_LOCATION
LARRY WATTS
Supplemental fields
FilePath
\MIGRATIONS\L\LOCUST TREE\14564\74-943.PDF
QuestysFileName
74-943
QuestysRecordID
1826458
QuestysRecordType
12
Tags
EHD - Public
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FOR OFFICE-USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No. .7y_..9y3.. <br /> ........ ................... This Permit Expires I 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 <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> f JOB ADDRESS/LOCATI �ti���lp ... !"' `.�L�... ...............CENSUS TRACT ............._....... <br /> .... <br /> Owner's Nome .............. .--...._Phone ............. ...................... <br /> '/ <br /> Address Cit <br /> 1��`7 ...�. <br /> - ------- - -------� --�..-- - - --------. y ... . .. - <br /> . <br /> Contractor's Name .. ....... <br /> . .-- -----_-- -- .license #��� , .?''"_ Phone ................ <br /> Installation will serve: Residence Apartment House-C] Commercial ❑Trailer Court ,❑ <br /> Motel ❑Other .... <br /> Number of living units... �.... . Number of bedrooms 3-------Garbage Grinder Lot Size _ <br /> Water Supply. Public System and name ..... ................ . .... -Private <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Cloy ❑ Peat ❑ 'Sandy Loam [eClay Loam ❑ <br /> Hardpan ❑ Adobe E] Fill Material ..... ...... If yes, type ........... ............... <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> INSTALLATION: (No septic tank or seepyge pit permitted public sewer i available within 200 feet,) �� <br /> W REATMENT [ ] SEPTIC TANK i Siz 'e�. ...........----- .. Liqui De th ...e--a - <br /> PACiCAGE ., � q p <br /> Capacity h Q.6 Type ._..._.._......__ Material..�. ._,w..._ , .. No. Compartments <br /> `f""��'� .-T.'........... <br /> Distance to nearest: Well <br /> . ...- /4-7 <br /> --- •-------------Foundation ....�-fir?-• ---•--- Prop. Line ----..�...--•._.... <br /> LEACHING LINE [� No. of Lines .�5. . Length of each line . . -$Q .". .... Total Length .-;�n_Va.......... <br /> 'D' Box . . Type Filter Material ..,.. -.---Depth Filter Material .... ....... <br /> Distance to nearest: Well ......, D.�....__...- Foundation /IV -'o....... __. Property Line .,�t__.�.............. <br /> SEEPAGE PIT [ 1 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) ... .. ..... ..............._............................---------------------- <br /> Disposal Field (Specify Requirements) ............... _-----_-------.. ._. <br /> . ... ............ ........ ...... ......... ---------------------- --- ----.....----------- . .......----- ------ -- ------- <br /> (Drd'w 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 <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents 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 manner <br /> as to become subject to W an's Compensation laws of California." <br /> Signed . ................. .............. . .... Owner f <br /> By Title ( - <br /> . .. <br /> (If other than owner) <br /> _ . <br /> FOR DEPARTMEdT USE ONLY <br /> APPLICATION ACCEPTED BY ... G-fir - •------• DATE . . /0 _/d ...-791.__.... <br /> BUILDING ` RMIT ISSUED . .. .. . ..... .... .. DATE _ <br /> . .. .._ ...._._. .... .......... ............ <br /> ADDITIONA COMMENTS .. . ..................... ............... .. . ....., ................ ............. ..........- <br /> ------- ---- --- ---------- <br /> • ................ ............. ............ ............ ---------- ....... --•--------._......... • ----_. <br /> Final Inspection by: - --------------------------------- -------- <br /> SAN <br /> •- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> I`` E. H.13 24 1-'68 Rev. 5M ___ 7172 3 ,K <br />
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