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17435
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4200/4300 - Liquid Waste/Water Well Permits
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17435
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Entry Properties
Last modified
12/16/2018 10:06:36 PM
Creation date
12/3/2017 1:45:46 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
17435
STREET_NUMBER
0
STREET_NAME
MCBRIDE
STREET_TYPE
AVE
City
ESCALON
RECEIVED_DATE
5/12/1964
P_LOCATION
EARL MCCOLLUM
Supplemental fields
FilePath
\MIGRATIONS\M\MCBRIDE\0\17435.PDF
QuestysFileName
17435
QuestysRecordID
1865338
QuestysRecordType
12
Tags
EHD - Public
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FOR Of-FICE USE; „ <br /> I&PLiCATIDN FOR SANiTATiOERMIT Permit No. ,. .(�` <br /> -- ------------------------------------------------------ (Complete in Duplicate) �—' <br /> Date Issued <br /> ------------____________________________________--_.-._ This Permit Expires 1 Year From Da _ <br /> mb <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 applicatiok <br /> s made in compliance-with Counfy Ordinance No. 549. <br /> 51 m- Al Bpi of � i � b <br /> JOB ADDRESS AND LOCATION - r--------------------------- SJR_NTH <br /> L <br /> Owner's Name-------------- L ' ---- Phone <br /> ------- <br /> Address-...............I _� _-_-_ � 5 '` --`---------•---------------------------r------------------•-•-----••----------: I <br /> Name Q. �1�1_ .• ---------------- --------------------------------- <br /> Contractor's Phone. ... <br /> kl ------ <br /> Installation will serve: Residence Q�zAparii7it House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> z r f- k <br /> Number of living units: '�:: '_ Number.,of.bedrooms�__—_ Number of baths _r----- Lot size __ �1 ---------------------- <br /> Water Supply: Public syste; ❑ Community syst m ❑� Private Depth to Water Table.3 _ ft. <br /> Character of soil to a depth of 3 feet: Sand Gravel ❑�..Sandy,Loam ❑, Clay Loam E] Clay ❑ Adobe ❑ Hardpan E]t # � <br /> Previous Application Made: {If yes,date-------------------. No .,,New Construction: Yes No ElFHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 1 <br /> (No septic tank or cesspool pefmifted if public sewer is available within 200 feet.) <br /> t f a / <br /> Sep#ic Ta Distance from nearest we}i___ �D+istance from foundation____I�J_____---__.M ial___.RE7p�ti_00D <br /> No. o{ compar#�ents--___--- -------..5#e..��.1-- - Liquid depth-.. .. _..}......._.Capacity.... __:... <br /> pisposal Field: Distance from nearest well_------'.--------Distance-from-foundationt-------------------Distance to nearest lot line--------------- <br /> ❑ Number of lines----------------------.-"T--------Length of each line------------------------------Width of french----• ti <br /> V- _ <br /> Type of.filter material-------------------------Depth of filter material--------------.--------Total length_---._-_-----___----._-_.__---__-__-_-_.- <br /> Y : I <br /> Seepage Pit: Distance_to nearest well----------------------Distance from foundation-__--_--__-_..._....Distance to nearest lot line--._.-___-_-___._ e% <br /> 171 Number,of pits----------------------Lining material---- ------.--.Size: Diameter---------------------Depth-- ------ oil <br /> Cesspool: Distance from nearest well-------___---.-_Distance from foundation____________________Lining material_______.____.__.___-----_---g-.__ <br /> ❑ Size:.Diameter------- ------------------ ---------.Depth--------------------- ------------ ---------------Liquid Capacity--------------- gals, +j <br /> 1 __-_....-Distance from nearest building <br /> Privy: Distance from nearest well------------- -------------- ----- - ---------------------------------- <br /> D <br /> ----------------• -------------- -.. <br /> ❑ Distance,to nearest lot line------------------------------- --------------------------------------------------------------------- <br /> I ISIn.' TR.NS REP,G-Ht _`4�U..__T1�_n!K j^I-----Pno�---- <br /> Remodeling and/or repairing (describe):_ __ - <br /> N�l _i1L Q �V-�TNS p . -E-- '--- I'.�`� <br /> �. -n-R,-Q -- <br /> i_ ---------------------------------------------- --------------- ---------- <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,�4nda �ullaftions f the San Joaquin Local Health District. <br /> Ic--------------------------(Owner and/or Contractor) <br /> (Signed)_ 's✓u --�"- ----- <br /> By - --- --------- - <br /> Title <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can 6e placed on reverse side). <br /> - FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------t-_-�_R�Q� - ----------------------------------- DATE------a� 4,-,--4�'` <br /> - ------------------------------ <br /> REVIEWEDBY---------------- ----------------------------- DATE------------------------------------------ -------------------- 1. <br /> BUILDING <br /> --------------=- <br /> BUILDINGPERMIT ISSUED------------------- ----------------------- ------------ ------ DATE--------------------------------------------------------- <br /> Alterations and/or recommendations: ----------------•--------------------------•- ------•------•---------•---------------------- <br /> y <br /> ----------------- ----------- „,._,- -------KtAVA°( (Ot --1---- -M----�44K ----�--------•---`--- -I--- `---------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------ <br /> i <br /> ______________________________________________________________ <br /> ____ _. --- --------------------------------------------------------------------------- <br /> .fes <br /> .� - --------- ----- - <br /> FINAL INSPECT IC*N�B_ r f -f7 Date.............. -------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1401 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> CS 9 REVISED 8.59 3M 3-'53 F.P.CD. <br /> r <br />
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