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EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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4317
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Entry Properties
Last modified
1/22/2019 10:03:01 PM
Creation date
12/2/2017 10:41:45 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
4317
STREET_NUMBER
409
Direction
S
STREET_NAME
LOS ANGELES
STREET_TYPE
ST
City
STOCKTON
SITE_LOCATION
409 S LOS ANGELES ST
RECEIVED_DATE
08/19/1953
P_LOCATION
LAWRENCE SMITH
Supplemental fields
FilePath
\MIGRATIONS\L\LOS ANGELES\409\4317.PDF
QuestysFileName
4317
QuestysRecordID
1828931
QuestysRecordType
12
Tags
EHD - Public
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r! ' <br /> 43/ 7 <br /> rincomplia <br /> / PLICATION FOR SANITATION PERMIT Permit No. ....... -- <br /> Vapppl�icafion <br /> (Complete in Duplicate) Date issued�j Apheree S n o uin Local Health District for a permit to construct and install the work herein described. <br /> Vi mnce wi Count Ordinance No. 549. <br /> This s1 y <br /> JOB ADDRESS AND LOCATION... D._ O� . -e-& I <br /> j --- ----- - --------- -------- <br /> j Owner's Name-------------------------------------Xc__ rt `------------ _ -- Phone----: = <br />( Address----------------•-------•-------------------------------------------- ,hw_� ------------------------------ ------------------------------------•----••--------------------------- - - <br /> Contractors Name - Phone - ------ - <br /> Installation <br /> will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ` <br /> Number of living units: __/---- Number of bedrooms ---'Number of baths :_/-_- Lot size _1 _d_._____.1!'__1_ _______________ <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table--------- ft. <br /> p Character of soil to a depth of 3 feet: Sand ❑ Gravel E].. Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> I Previous Application Made: Yes ❑ No ® New Construction: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if pu�lic wer is available within 200 feet.) <br /> ` Septic Tank: Distance from nearest well-;���_____-Distance from fgundation--ID lvla`�te//r'�i�l__._-�-�C �_______ <br /> ® No. of compartments.._____..'. _._________Size___tl___ __f __ .�-.Liquid depth._._----4--------------Capacity-__ _070-..._ <br /> Disposal Field: �/0� Distance to nearest lot line---x5____l� _ <br /> `Distance from nearest we!I_-_�_._____Distance from foundation_ __ _-._r <br /> " [ Number of lines-.-.'...___�_._,. -Length of each tins_ U .. l�``� ..Width of trench._._--. 0� --- �,.___..-____--- <br /> Type of filter material-_.5„ -��Depth of filter material--__- -?. .......Total length_-------..1_ __ <br /> Seepage Pit:' Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line------------------An/- <br /> ❑ Number of pits----------------------Lining material--•--------------------Size: Diameter-------------- ---=----Depth--------------------------------- <br /> Cesspool: Distance from nearest,well-----------------Distance from foundation Lining material---------------------------.-_.------ <br /> 1 ' De th cs y g l <br /> Sipe: Diameter--------------------- r---- 1_uid..Ca a '# Y: a s <br /> Privy: '�'" Distance from nearest well -------------------------- Distance from nearest building-2---. ---- <br /> ❑ --- <br /> Distance to nearest loft line. <br /> r , <br /> Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------------•-------------------------------------------------------- <br /> --•---•------------------------------------•-----•--------=------------•------•--------------•---------------------------•------------------------------� -- ------ -------------..------------------------------------- <br /> { b <br /> ------------------------------------------------------------------------------ ...- <br /> ------------------------------------ ------------------------------------------------•------------------------------------------------------------------•-------------- ---------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Counfy-: <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 'f <br /> s <br /> (Signed)_-- - - kt t,� - --- ----- - p -- -------------------------------(Owner.and/or Contractor) <br /> IBy:-----------------------___------------------------------------------------------ ---------------------------------------------(Title)-------- '--------- <br /> (Plot plan, showing size of,lot,,loca+ion of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DPA T USE ONLY <br /> APPLICATION ACCEPTED BY---- -------- --- ----------------- DATE- l 1 ................... <br /> REVIEWEDBY------------------------------------- --------------- -----------------------;---------------------------------------------- DATE------------------------------------ <br /> BUILDING PERMIT ISSUED ..... ------------------------------ DATE--------- ----- <br /> Alterations and/or recommendation s:--�'�-�' �-a-- t . --- -- /... _._. - ___.__ <br /> --- ----- ------ -°----- --��'-��'!" `-==- '---- ------- - - ' -•"A -' - _' c--- _! " - 41,e':� �------ <br /> -----•----------------•-------•-• -----------..-------•--------------•-------------------------------------- n <br /> --------•------------------------------ -------------------•- --------•-------•--------------------•---• ----------------------- ---------•------------------------------------ ------------------------------------- -------- <br /> FINAL INSPECTION BY:. +®�' bate <br /> i <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--9-21v1 is-52 Revised W-2100 <br /> z F <br />
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