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2486
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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N
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99 (STATE ROUTE 99)
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12404
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4200/4300 - Liquid Waste/Water Well Permits
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2486
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Entry Properties
Last modified
11/19/2024 1:52:44 PM
Creation date
12/3/2017 4:37:39 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
2486
STREET_NUMBER
12404
Direction
N
STREET_NAME
STATE ROUTE 99
APN
06108017
SITE_LOCATION
12404 N HWY 99
RECEIVED_DATE
04/29/1952
P_LOCATION
DELTA P SARVER
Supplemental fields
FilePath
\MIGRATIONS\N\99 (HWY99)\12404\2486.PDF
QuestysRecordID
1874527
Tags
EHD - Public
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APPLICATION FOR-SANITATION PERMIT ermi No�` <br /> D <br /> i <br /> l <br /> (Compete n Duplicate) <br /> i Date <br /> '�• Applicaf�is'hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This•_, p lication is adle-ic ante with C unty Ordinance No. 549. <br /> U .JOB ADDRESS AND WLC TION__`�rQ/r�M <br /> Owner's Na a ----- ---- �y ----------------------------- -- ---------- --t-- -------------------------- <br /> Phone . <br /> ----------------------------------- <br /> • ------------ <br /> I' Address_..----[�--' .a �k�'�---- �1- �{�- ..... , <br /> I Contractors Name--.-1 'l----- - ------------------------- x_t,,& � Phor�e <br /> v r s..c..a... <br /> Installation will serve: Residence Apartment House ❑ Commer al ❑ Trailer Court ❑ Motels Other ❑ r <br /> Number of living units: ' Number of bedrooms _ SNumber of baths _j_ of size Z-190---- --- - <br /> Water Supply: Public system ❑ Community system ❑ Private [1/Depth to Water Table,�.;,�yff. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy LoamClay Loam ❑ Clay ❑ Adobe ❑ Hardpan <br /> Previous Application Made: Yes ❑ No R/ New Construction: Yes ®/No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public ew r if available within 200 feet.) r <br /> •f r2 <br /> ht,u,,,. n <br /> Septi a k: Distance from nearest well_________ _____ istance from foundation--_-__�_i/-______.Material___ ___-_ <br /> =R-r� No. of compartments__ ' ----------Size-------------- ----------------Liquid depth__----------------------- Capacity - � <br /> Disposal Field: Distance from nearest well------------------ from foundation--------------------Distance to nearest lot line_________________ <br /> I] Number of lines-----------------------------------Length of each line------------------------------Width of trench------------------- -- --------- <br /> Type of filter material---------- ------ ----Depth of filter material----------------------Total length--------------------------------_-y---- <br /> Seepa Pit: Distance to nearest w I �"� Distance m�foundation___.Di ancVo nearest lot lie__- --__-_ <br /> - , �. <br /> Number of pits----------------------Lining material---------------------- ue: Diameter-------�-Q--------Depth-------------- --------------•- <br />' Cesspool: Distance from nearest well-----------------Distance from foundation-------.------------Lining material-__-_---_---___-------_-----______-_ <br /> ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity--------------------------9al <br />' Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------------- <br /> ❑ Distance to nearest lot line---------------------------------------------------------- ----- ------------------------------------------------------------- 1 <br /> i Remodeling and/,or repairing (describe):---------------------- ------ --------•--------------------•---------. <br /> --------------------------------------------------------------------------------- i <br /> ---•------------------------------------------------------------ <br /> ----- --------------------------------------------------•---------------------------------------- <br /> hereby certify that ! have prepared this application and,that the work will 6e done in accordance with San Joaquin Coun <br /> ordinances, State laws, and rules and r gulations of the San Joaquin Local Health District. <br /> (Signed)_ -'.---- -------••--- --- -- -- --- --- •--------------------------------------------------------------- ----------- and/or Contractor <br /> -------------------------------------------------- Title <br /> By:- ----- ----- ------ ---- --- --- -_. <br /> (Plot plan, showing size of lot, ocation of system in relation to wells, buildings, etc., can be placed on reverse sid`e): <br /> FOR DEPARTMENT USE ONLY <br /> 1 APPLICA`iION ACCEPTED BY-_��_.....-,.,!-------------------------------------------------------------------------- DATE_. F. <br /> REVIEWED BY--------------------------------- -------------------------------- DATE- <br /> --------- - -- <br /> ------------ --- ----------------------------- - <br /> BUILDING PERMIT ISSUED----------- - ------- - ------------------ DATE <br /> Alterationsand/or recommendations:-------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------•------•-----------•----------------------------- <br /> ------------------------------------------------------------ ----------------- ----------------•---------------------------------- <br /> --------------------------------- <br /> ---r-------------------- --------------------------------------------------------- <br /> - <br /> M / ........ ------------------- <br /> FINAL INSPECTION BY: --------------- ------------------- <br /> 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 C–elifornia�„ Lodi, California Manteca, California Tracy, California <br /> ES-4-2M 8-51 Revised W-2100 <br /> i <br />
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