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4629
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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MADISON
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2054
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4200/4300 - Liquid Waste/Water Well Permits
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4629
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Entry Properties
Last modified
1/24/2019 3:45:02 AM
Creation date
12/3/2017 12:01:38 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
4629
STREET_NUMBER
2054
Direction
S
STREET_NAME
MADISON
STREET_TYPE
ST
APN
16515111
SITE_LOCATION
2054 S MADISON ST
RECEIVED_DATE
11/27/53
P_LOCATION
RR MC DANNALD
Supplemental fields
FilePath
\MIGRATIONS\M\MADISON\2054\4629.PDF
QuestysFileName
4629
QuestysRecordID
1836575
QuestysRecordType
12
Tags
EHD - Public
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APPLICATION FOR SANITATION PERM] �� Permit N . '7_'"---!-__. <br /> (Complete in Duplicate) <br /> �� � -✓ pate issued _. <br /> Applica{ion is hereby made to the San Joaquin Local Health District for a permit . constr�i-ct and install the work herein described. <br /> h0 S S �d►� ria`o S7� ^wCounty Ordinance No. 549. , <br /> This application is made ith C , <br /> p.P _ m com Pliance <br /> - ---- ( <br /> JOB ADDRESS AND LO ATION?A �. _ . ----- ----- - ------------------------ ----- <br /> Owner's Name......... <br /> -- Phone__.. _�® ------------- <br /> Address <br /> �� � <br /> -. ------�. ---------------- - <br /> 's Name �---------- --------------------=-----------•--------- •--------- Phone-- / -------------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _/_-_- Number of bedrooms _,c.- Number of baths _ -- Lot size _...-`Sd <br /> Water Supply: Public system 10' Community system ❑ .Private ❑ Depth to Water Table vZ <br /> Character of soil to a depth of 3 feet:. Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay❑ Adobe ❑ Hardpan"❑ <br /> Previous Application Made: Yes ❑ NoNew Construction: Yes No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: y <br /> (No septic tank or cesspool permitted if public s6 of is available within 200 f�}� Material________' i- <br /> Septic Tank: Distance from nearest wefl4____ __Distance from foundation__-. ---------------'---:-------- <br /> ® No. of compartments�.______°z t__,--------Size_s6�Xy�A'-5`---Liquid depth----- x�._._-:--'Capacity.-.C?,a- --------- -�J, <br /> Jtt�,,, <br /> Disposal Field: Distance from nearest well��a J�Distance from foundation__., .-.Distance to nearest lot line------------------ <br /> .Number of lines`-.--.Z--------------------------Len`gth of each 4ine---- - -------------- .Width of french-----�y��----------------•--. <br /> Type of filter materna!_ _ -___.__Depth of filter ma <br /> Seepage <br /> .___._.__Total length-------- _Q_ ____________________ (3 <br /> Seepage Pit: Distance to nearest well---.-_--!_.---------Distance from foundation- to nearest lot line_________________ <br /> ❑ Number of pits-----'-.--'------.---Lining material------------------._.Size: Diameter*----------- --------Depth-------_------------------------ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation----------------1._.Lining material--_-..._._.._._____-___._________-_-. <br /> ., ❑ Size: Diameter------------- --------------------- Depth ---.-_--------------•---- -- '--Liquid Capacity gals. <br /> Privy: Distance from nearest well------ ___.'Distance from nearest building_.______.__.____-.-...---------.-_____. i <br /> ❑ Distance to nearest lot line'. - -- -- . -=---- ---------------'--------------------------------- ------------------------------t <br /> Remodeling and/or repairing (describe):_= Gl.� � { -`" �� cP'u - ----- ------ '------a <br /> - -_ ----------------- ---------------------------- ------ <br /> - <br /> = - --------------- <br /> t <br /> -- -- ------------- <br /> ---------- <br /> ----------------------------- --- <br /> U �` k ---------------- <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 /> -- <br /> (Signed) - .�--------- ----�--------------------- ---+- -------------------------- - Owner and/or Contractor) <br /> C.c/ - ---, 1` ------- ---------------------------------------------- ------(Title)- --- <br /> By:------ ------------- <br /> (Plot plan, showing size of lot, locati 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 /> - -53 -------- <br /> REVIEWEDY --- - - ------------- -- - ------------ --------------------------------------- DATE---•----- ------------- <br /> I � Dr�r _'"k�.. -=------`------------------ -r. ------=-'-----=---F -D=AFTE--------------------•----------------------------------------- <br /> ------------------------------------------------------------ <br /> Aaatonnd/or recommendations:. - 1A---- --------------------------------------------------------- <br /> M <br /> ---------- ------ ---- / - <br /> ---+----- <br /> --h--- -- ------- - ------------------------------------------------ <br /> A <br /> - ------- <br /> ---------------------------------f- <br /> A---------------- <br /> ----------- f..1n'1, - --- - - <br /> -- <br /> FINAL INSPECTION BY: = � Date---/1-- =~ -- ---------- <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 /> k Fr—q...7M RAVkAd YY-2100 _ - y <br />
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