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69-311
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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69-311
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Entry Properties
Last modified
2/12/2019 10:30:57 PM
Creation date
12/3/2017 12:17:40 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
69-311
STREET_NUMBER
3811
Direction
E
STREET_NAME
MAIN
STREET_TYPE
ST
City
STOCKTON
SITE_LOCATION
3811 E MAIN ST
RECEIVED_DATE
04/24/1969
P_LOCATION
DOYLE KING
Supplemental fields
FilePath
\MIGRATIONS\M\MAIN\3811\69-311.PDF
QuestysFileName
69-311
QuestysRecordID
1838443
QuestysRecordType
12
Tags
EHD - Public
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FOR OFFICE SP- <br /> APPLICATION FOR SANITATION PERMIT <br /> -7 --------------------------;, ` Permit No. <br /> (Complete in Triplicate) ; <br /> ------=--=---------------------------------------------- " p. <br /> Date Issued <br /> ----------------------------_-__ -----_---------- This Permit Expires 1 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 ; <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ------- _ `- ----------------------E,�---- -M_ --a-` <br /> I -----------CENSUS TRACT -------------------------- ; <br /> Owner's Name -- bball, ------ FV, R <br /> � <br /> C <br /> Phone------------------------------------ <br /> Address ------ city- ---------------------- <br /> Contractor's <br /> Name -------,�---------- -----------------------=--------Lice nse# Itp-- - _ Phone -------------------------.---- <br /> Installation will serve: Residence 0 Apartment House-[:] Comp�(cial :❑Trailer Court i❑ <br /> Motel ❑ Other <br /> Number of living units:_"'___ Number of bedrooms-�*'------Garbage Grinder $_____ Lot Size ----X_1__Z_10------------- t <br /> Water Supply: Public System and name 4 4 T --------Jr-f a- _-'r------ -------------------------------------------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand❑ Sift❑ Clay E] Peat[_1Sandy Loam E] Clay Loam ;❑ ? <br /> Hardpan ❑ AdobeMaterial If yes, type ____________________________ rr__,, <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.) q6V� <br /> NEW INSTALLATION: (No septic tank or seepage .pit permitted if public sewer is available within 200 feet,) , �+ <br /> PACKAGE TREATMENT [ ] SEPTIC ThNKT + Size.._--_____:_ Liquid Depth ----1�_________________ <br /> [1 -_ �X ----- q p <br /> 1I-ot <br /> MateriaE_��-Y �^!---- No. Compartments ___` __;___..:__.. <br /> Capacity _ ----n----- Type <br /> rp t *� <br /> Distance to nearest: Well ------------------------------------Foundation -------�-------____-- Prop. Line ----•__--- <br /> i <br /> LEACHING LINE (] No. of Lines ----------------------- Length of each line----- C_�--r------------ Total Length --- U-----------•----- i <br /> + / It <br /> 'D' Box __M- ---- Type Filter Material _____/ _______.Depth Filter Material -------1_____------_____/---------_--._--- <br /> Distance to nearest: We -------- -------- Foundation _-____-_�__ _--_____ Property Line ` ____.-._._________-- <br /> SEEPAGE PIT De Depth __a ---------- Diameter .33"______ Number ---------1------------_.__ Rock Filled Yes (� No i❑ <br /> Water Table Depth ----------- Q7 $-----------------------------Rock Size _) Z--`_'------------------- <br /> Distance to nearest: Well -------------_°--.--------------------Foundation, .......... Prop. Line ....___ ............. <br /> ,I f <br /> REPAIR/ADDITION(Prev. Sanitation Permit�# ---------------------------------------- - Date.---:-----------------------------.) <br /> Septic Tank (Specify Requirements) --------------- ----------------------------------------------- -- ----------------------------,?•------------------•-------- <br /> Disposal Field (Specify Requirements) --------------------------- <br /> L ----------------------------- -------------------------- ------------------------------------------------------------------------- -- --- ---------------------------------- ------------------------- <br /> t <br /> t (Draw 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 Workman's Compensation laws of California." <br /> Signed ------------------------------------------------------------------------- Owner <br /> - <br /> -._ Title - - : --- -------------------------------------- <br /> By <br /> ----------------------------------- <br /> (If other than owneri <br /> E OR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----- ------------------------------------------------------------------------------. DATE ------ - --- <br /> BUILDINGPERMIT ISSUED ----------- ----------------------------------------------------------------------------------- -DATE ------------------- --- ------ <br /> ADDITIONAL COMMENTS --- ----------------- <br /> F `1 <br /> -------------- -------------------------- --- XIS------ - <br /> --- <br /> _ <br /> -- ------------------------------------------ ------------------------------ <br /> = 6D ---------------- <br /> -------------------------------- ate <br /> Final Inspection b --- <br /> {J� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E:-H. 9 1-'68 Rev. 5M. - e J <br />
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