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4200/4300 - Liquid Waste/Water Well Permits
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6794
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Entry Properties
Last modified
2/4/2019 10:12:17 PM
Creation date
12/3/2017 12:08:29 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
6794
STREET_NAME
MAIN
City
MANTECA
SITE_LOCATION
N MAIN 1ST HSE POST 1420
RECEIVED_DATE
10/11/1955
P_LOCATION
C TOQLIABUE
Supplemental fields
FilePath
\MIGRATIONS\M\MAIN\0\6794.PDF
QuestysFileName
6794
QuestysRecordID
1837968
QuestysRecordType
12
Tags
EHD - Public
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�l <br /> APPLICATION FOR SANITATION PERMIT �}�• Permit No. .--(f- _ <br /> (Complete in Duplicate) <br /> Date Issued ----- 3-- <br /> Applica+ion 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 54,,99 <br /> JOB ADDRESS AND LO TION__-- - ------- cflr•---1----/-_�---SGS-- ----- -- .. ._ <br /> � '� <br /> ------------- --- <br /> Owner's Name------ ----- -- -------------------------------------------------- --------------------------. Phone-------- --------------------------- <br /> Address..--------------------------------- / <br /> Contractor's Name--------------- ------------ k��---------------------------------------------------- -------------- <br /> --.-.._- Phone._.._...---••----------•----------• <br /> Installation will serve: Residence o-'-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: / ____ Number of bedrooms _5--- Number of baths J__._ Lot size ------`______________________________________________--_-. <br /> Water Supply: Public system ❑ Community system rivate ❑ Depth to Water Table ------ ft, i <br /> Character of soil to a depth of 3 feet: Sand Gravel❑ Sandy Loam �y Loam [] Clay El Adobe E] Hardpan F]Previous Application Made: Yes E] No New Construction: Yes H--�_o ❑ <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__75_______.Distance from foundation_-_-A----___._. <br /> Liquid de th._.__13-_-..__ <br /> No. of compartments-_*-.---`�-r ----Size_��.� `�:-- --- q depth___13 <br /> Disposal Field: Distance from nearest well.15..........Distance from foundafioP___ ____. ,Distance to nearest lot line t -_:_____- <br /> Len Length of each line o ' �°, � i° <br /> Number o1 lines - j <br /> g °---- -�� s- -- -----Width of french .--------- <br /> of filter material_ _e Depth of filter material....`_e-e_____--Total length-__.___-.a__ ___ ------------------ <br /> Type + <br /> Seepage Pit: Distance to nearest well-----___--------------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> 0 Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth..-----------------_------------- 9f <br /> Cesspool: Distance from nearest well-----------------Distance from foundation:-------------------Lining material------------------------------------- <br /> ❑ Size: Diameter------------------------ ----------Depth----------------------------- ------- -------------Liquid Capacity-----------------------------gals. . <br /> r - <br /> = rivQis.tamce fxom-�nearest-welly — building_- _ <br /> ❑ Distance to nearest lot line-------- ------------- <br /> I <br /> Remodeling and/or repairing (describe)---------- ------------ --------------- ------------------------------------_--------------•-- ------------------------------------.------------•---- <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 r les andregulation of the San Joaquin Local Health District. <br /> S- - --------- --- ---------- <br /> (Signed) --------------------------------_--------Owner and/or Contractor <br /> By:-------------------------------------------•-------------------------.--------------- --------- ------------------------------------(Title)--------------------------------------------------------------- <br /> (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ' <br /> 4 <br /> ART NT USE NLY _ t <br /> APPLICATION ACCEPTED BY.._._ <br /> ---- -- � ------- ------- -- -- ---- --------- ---•-------- ;..DATE--------- <br /> --- ��--- ---�/-- ---0--�•�------------------- ( <br /> REVIEWEDBY-------------------------------- - --------------------------------------------------------------------------------------- DATE------------------------ <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------ ----------------------------------- DATE----------------------- <br /> -•-----------•---•----- <br /> Alterations and/or recommendations:--------------------------------------------------------------- -----------------------•-----•---------••-----•---•-----••-- i <br /> F <br /> ---------------------------------- ----------------------------------'---------------------------------------------------------------------.--------------------------------------------------------------- ....... <br /> 4 <br /> FINAL INSPECTION BY------------ --- ---------•-•- ------•---- Date.- ---- .....--- ------------------ - <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 /> x <br /> ES-9-2M 145446 ATWOOD 12.54 <br />
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