My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
12943
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
M
>
MARIPOSA
>
2373
>
4200/4300 - Liquid Waste/Water Well Permits
>
12943
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
10/31/2018 12:12:34 AM
Creation date
12/3/2017 1:14:24 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
12943
STREET_NUMBER
2373
STREET_NAME
MARIPOSA
SITE_LOCATION
2373 MARIPOSA RD
RECEIVED_DATE
3/20/1961
P_LOCATION
CENTRAL VALLEY PIPE CO
Supplemental fields
FilePath
\MIGRATIONS\M\MARIPOSA\2373\12943.PDF
QuestysFileName
12943
QuestysRecordID
1844396
QuestysRecordType
12
Tags
EHD - Public
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
2
PDF
View images
View plain text
FOR OFFI USE _ <br /> ___-__-_ ________________---____________ PLICATION FOR SANITATION PERMIT Permit No. <br /> ---------------------------------------------- --------- (Complete in Duplicate) G <br /> - <br /> -------------------------------------------------------- This Permit Expires 1 Year From Date Issued <br /> 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 <br /> 2Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION------- - -------------- <br /> -----------------------------------------------------.-_-----••------------ <br /> -f^ 0ffOwner's Name---------d'f4Kt ---.....0apok-e-0.....I(------------------- --------------------------------------- Phone------------------------------------ <br /> Address---------- . ----------------------------------------- ------------------------------------------------------------------------------------- <br /> Contractor's Name-----------------•%G ' 4 ------------------------------------------- Phone <br /> Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _/___ Number of bedrooms –1— Number of baths rZ, Lot size ,___-------- ---------- <br /> Water Supply: Public system ❑ Community system ❑ Private RQ- 7 pth to Water Table 7ZA;?'lt. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe lardpan ❑ <br /> Previous Application Made: (if yes,date-------------- --) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Sep icjan : Distance from nearest well-________________Distance from foundation--------------------Material------------------------------------------------- <br /> Ja' No. of compartments------------- ------------Size--•------------•----------------Liquid depth---n---------------------.._Capacity------ ----•- <br /> sal RI/, r7`— <br /> Dispol Distance from nearest well_ BP-----Distance from foundati n ._-�t-_-__----Distance to nearest lot lin ---_---_ <br /> Number of lines----____�_-----_ --. �r Length of each line--- Q- �----- -.Width of trench, --- e <br /> Type of filter material_ , �G/Lf]epth of filter material_/�<!-`.-_--Total length------� _�--------------------! 4 <br /> r' NP `` lis --.Distance to nearest lot line..,_ �] <br /> Seepage P' Distance to nearest well-_.-1��-_Distance fr m foundation___ _______ <br /> tr i C <br /> "V <br /> Number of pits------1------------Lining material._ _ ,Size: Diameter.�.F-.._----__.Depth--12., ------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- <br /> El <br /> ----.- .------_----_.---_-----. v <br /> ❑ Size: Diameter----- --------------------------------Depth------------------------------ ---------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-----------------,,__-_.-----_-_---------.-_------Distance from nearest building-------.--------._----_----_-----------_-. <br /> ❑ Distance to nearest lot line-- ------------------------------- ------------------------ -----------------------------------•------- --------------------------------- <br /> Remodeling and/or repairing (describe):------------------< ------ -------------•----------------....-------------------------------------- <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 /> ----------------------------------------(Owner ani or,Contractor <br /> {Signed) iII �J" ( ] <br /> By:------------------------------------------------------------------------ • --•-----------------._{Title]----- J ��i,' --..... ----------- - t <br /> (Plot plan, showing size of lot, location of system in r tion to wells, buildings, etc., can be placed on reverse side]. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-----01.......�1- *---------------------------------------------------------------- DATE---- Z` :-.{o.s--------------------------- <br /> REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- <br /> Alterationsand/or recommendations:-------------- ----------- ----------------- -------------------------------------------------•-------•-------- ---------------------------------------------- <br /> --------------I----------------------- <br /> -----------------------------------------------------•-------------------------------------------------------•----------------------------------------------------------------•--•---------------------------------------•-•------------------------•----------- <br /> -------•----- --------------------------------------------------------------------- ------------------------•--•-------------------------------- -•------------------------------------------------------------------------- <br /> FINAL INSPECTION BY: Lam.- ------------------------ Date------- . b_�--------- ----------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> y � <br /> 130 South American Street 300 West Oak Street 134 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> E9-9 REVi9E0 9.59 r.n,C0-XM 6-60 tt '/ <br />
The URL can be used to link to this page
Your browser does not support the video tag.
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).