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13676
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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13676
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Entry Properties
Last modified
11/14/2018 12:23:47 AM
Creation date
12/3/2017 12:57:35 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
13676
STREET_NUMBER
0
STREET_NAME
MARIPOSA
STREET_TYPE
RD
City
STOCKTON
SITE_LOCATION
RT 4, BOX 463 C-10/MARIPOSA RD
RECEIVED_DATE
11/8/1961
P_LOCATION
P E FUNK
Supplemental fields
FilePath
\MIGRATIONS\M\MARIPOSA\0\13676.PDF
QuestysFileName
13676
QuestysRecordID
1844015
QuestysRecordType
12
Tags
EHD - Public
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�'l�`f <br /> ----------- <br /> 0;\U 'rar�wt�vt;��,i S�-pz� <br /> --- ----------------�1-----------------------------•---- APPLICATION Felt SA IA �P�11tMI I Permit No. .4 t-' <br /> (Complete in Duplicate) <br /> ----- This Permit Expires 1 Year From Date Issued 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 made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AN LOCATION...__ <br /> \\ /` <br /> Owner's Name ` Phone 11n- A� <br /> Address1Z.3*-----• _ �)� � • -------------------- -•_........._..-- <br /> Contractor's Name .-.--1•�---- --..------ ` �-'Q'q. -. -------•-----_............. Phone.fu4..�-'1 ../�°.� <br /> Installation will serve: Residence Apartment House EL Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> f <br /> Number of living units: A_- Number of bedrooms . Number of baths j_____ Lot size __-.q �x-_1C..1!�i'� <br /> _-_1C-l!� <br /> Water Supply: Public system ❑ Community system ❑ Private 2-Depth to Water Table -a ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe( 'Hardpan ❑ <br /> Previous Application Made: lif yes,date--------------------I No ❑v-''New Construction: Yes ERNo p FHA/VA: Yes ❑ No [Cy <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 204 feet.) <br /> Sep�isposall <br /> ic Tnk: Distance from nearest well-----------------Distance from foundation-------------------.Material--_____---_____._._.--_._...___••••••••-••--•-_-• <br /> No. of compartments----------------•--------Size-----•--------------------------Liquid depth-------------- ------ --Capacity <br /> �d: Distance from nearest well_________________Distance from foundation-______..__..--____Distance to nearest lot line................. <br /> Number of lines-----------------------------------Length of each line------------------------------Width of trench......-----_-...- _ <br /> Type o alter material._•----------------------Depth of filter material----------------------.Total length_.......................----•-------•--.-- <br /> r <br /> Seepage Pit: Distance to nearest well______'___f"------Distance from foundation....OQ �...•_..Distance to nearest lot line..,_...__ <br /> Number of pits------- -------------Uning material--- . _...--- ----.Size: Qiameter-__--_6- ---_---.._Depth.------t.Q------_•-------_-- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----------------._...._ <br /> El <br /> Size: Diameter-----------------------------------•-Depth---•----------------------------- ------.._Liquid Capacity----------•--------------...gals. <br /> Privy: Distance from nearest well_________________________________________ ____--Distance from nearest building_-_______--._______-_. <br /> Distance to nearest lot line <br /> Remodeli and/or repairing fdescribe)______________ -------------- <br /> t`�'"-'-�"�__•-.• C.____-_-_ _ r <br /> •---------••-•-------- ---------- -------------•-•------• --------------------•-----------•••----------•----------------------- <br /> ..--••--••---•---------------------•-------•----•---•-------•----------•--•------•------------•------------•--------••--------- <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 rules and regulations of the San Joaquin Local Health District. <br /> (Sied -. % ~ <br /> gn }.._. 4�._ _ ✓� - ------•-•------•------------------"_(Owner and/or Contractor) <br /> 13y.. - -----•----------------•... ------------------•..._-....(Title)--- = <br /> (Plot plan, showingsize of lot, ocation of system in relation to wells, buildings, etc., can be placed on reverse side). 1-4' <br /> F R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY DATE <br /> REVIEWED BY---------------•-- = QATE { - <br /> BUILDING PERMIT ISSUED — Df4TE <br /> Alterafions and/or recommendations-----------------------------------------,------------------------------- <br /> ..------- .. <br /> FINAL INSPECTION BY---- ------ ------ =-- ----------- Date 1_ -�. .�_ <br /> - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wert Oak Street 124 Sycamore Strout 205 wort 9Th Street <br /> Stockton,California Lodl,California Manteca,California Tracy,California <br /> ES 9 REVkSEo S-a9 YM 5-67 ATLAS ' <br /> }' <br />
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