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21930
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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LOWER SACRAMENTO
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25600
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4200/4300 - Liquid Waste/Water Well Permits
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21930
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Entry Properties
Last modified
1/8/2019 10:25:13 PM
Creation date
12/2/2017 11:29:11 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
21930
STREET_NUMBER
25600
STREET_NAME
LOWER SACRAMENTO
STREET_TYPE
RD
City
ACAMPO
APN
00528001
SITE_LOCATION
25600 LOWER SACRAMENTO RD
RECEIVED_DATE
6/13/67
P_LOCATION
FRED PETERS
Supplemental fields
FilePath
\MIGRATIONS\L\LOWER SACRAMENTO\25600\21930.PDF
QuestysFileName
21930
QuestysRecordID
1834473
QuestysRecordType
12
Tags
EHD - Public
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FOR OFFICE USE: <br /> ------ ----- ----------------- ----------- Permit No. . <br /> Z. Q <br />- <br />-------------------------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) Date Issued <br />----------------- <br /> ------------ ----------------------- This Permit Expires l Year From 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.,madp_in.compliance_w.ith.C rdipance No. 549. t)D5—Z?-0 —n! <br /> JOB ADDRESS AND LOCATION .. / �" -• �T <br /> 10 <br /> Owner's Name--------N.Y. =•--••--�•--- ------------------- - <br /> --- Phone.---••----------••---------••------- <br /> Address--------------------•----- ---•-•-------------••- ---------------- --------------------- <br /> --- --- <br /> ------------- <br /> - Phone. + ._ .®_g <br /> Contractor's Name---------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [INumber of living units: j--- Number of bedrooms _` - Number of baths -_/__ Lot size ____---��----- •••• <br /> Water Supply: Public system ❑ Community system ❑ Private [y Depth To Water Table _SQ_Pft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam,k Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No�9 New Construc-�ion: Yes ❑ No W FHA/VA: Yes ❑ NoW <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 neares+ well_________________Distance from foundation--------------------Material--------------------------------------............ <br /> ❑ No. of compartments--------_------•------ Size-----_--------- Liquid del?th--------------------------Capacity----.------•- <br /> DisposalField Distance from nearest well--%1' e <br /> 0..._Distance from foundation___ .d.____.Distance to nearest lot lin .. <br /> Iff Number of lines---------- -------- Length of each line______---�Q__�_r-_.Width of french.___. 4 _�.-.-----•••_--- <br /> Type of filter material... -----Depth of filter material _ __Total length-----------R��--------------- - <br /> Seepage Pit: Distance to nearest well---/Z .--Distance fr m f ndation--- Q_.___.....Distance�to nearest lot line.__-__._.. - <br /> Number of pits.___------------Lining material___ -----Size: Diameter___22-_22 --- C74-57________________ I <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-------------------lining material------------------------------------- <br /> ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity---------- ------•----- 9 <br /> Privy: Distance from nearest well ____..._---------------------------------------Distance from nearest building---------------_-------------- <br /> ------ n <br /> ❑ Distance to nearest lot line------------------------------------------------------------------ <br /> - <br /> Remodeling and/or repairing (describe):----------------- ------••-------•------•--------•-------•----•-•-••---- -------- �1 <br /> f -------•- -------------------------------------------------------------•----------------------------------------------------- ---------••------------------•------------------------------- --------------------- I <br /> ----- -- - -----------------•------•------•-------------------------------------------------------------------------------------------•-------------------------------•------•------------- ---- <br /> 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. 1 <br /> 1 <br /> ------------------------------------- and/or Contractor) <br /> (Signed)------------------------ _ rile <br /> 1 - ---- -----( )------ G�-``"`� <br /> (Plot plan, showing size of lot, location of s tem in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------- - - --- DATE.. a -f 3- y <br /> REVIEWEDBY--------•-------------------------- DATE--------------------•- --------. -------- <br /> BUILDING PERMIT ISSUED--------- •- ------------ ----------- DATE. 9 <br /> A€terations and/or recommendations:----•----- ---- --- -- ---•----•-----------•-----•--------------•-----• ------------------------ <br /> --- ----------------- ------------------------------- ' ,) p-=�-- . <br /> --------------••----------• --------------------------------------------- <br /> ' FINAL INSPECTION BY:. - •------•--------• Date------------ - -- --------------------------------- <br /> SAN <br /> -----•--------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED S-59 2M 5-62 ATLAS <br />
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