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22429
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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99 (STATE ROUTE 99)
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13120
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4200/4300 - Liquid Waste/Water Well Permits
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22429
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Entry Properties
Last modified
11/19/2024 1:52:44 PM
Creation date
12/3/2017 4:39:48 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
22429
STREET_NUMBER
13120
Direction
S
STREET_NAME
STATE ROUTE 99
City
MANTECA
APN
20603021
SITE_LOCATION
13120 S HWY 99
RECEIVED_DATE
10/11/1967
P_LOCATION
LEROY CARDOZA
Supplemental fields
FilePath
\MIGRATIONS\N\99 (HWY99)\13120\22429.PDF
QuestysFileName
22429
QuestysRecordID
1879821
QuestysRecordType
12
Tags
EHD - Public
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FOR OFFICE USE: <br /> ---------------- -- <br /> Z <br /> - <br /> -----------------------------------------------__-- - APPLICATION FOR-SANITATION PERMIT Permit No. . CT ,� <br /> (Complete•in Duplicate) p <br /> ---------- ........... ----------- --. This Permit Expires 1 Year From Date IssuedDate Issued <br /> -(56~-oeo_-_1 I <br /> Application'is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein'Se'scribed, <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB'ADDRESS-AND LOCATI me4--- _. 9 - <br /> 1` ` Ro, t7^R F _>?_r:_..C3TwN. 1A_Tf O _ f1 t �p <br /> Owner's Name-------------- ------- E_ROy - -- R_QQz4n&-- <br /> . -_ _ __--------------------- Phone------------------------------------- <br /> Address <br /> _..____.________________________ <br /> Address-------•------- ......._W----•------�,1 1 C� -------------- mrC - -----`----------------- -- <br /> Contractor's Name....&4A11 -- ------ Phone---------------•---------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __r.___- Number of bedrooms :. __ Number of baths ;2;7_- Lot size ..... #C_ _ <br /> Water Supply: .Public system E]. 'Community system ❑ Private ❑ Depth t Water Table/z, ft <br /> Character of soil to a depth of 3 feet- Sand E] Gravel E] Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date_-...__.-- - _ No a 0 <br /> 2 New Construction: Yes ❑ No [.� HA/VA: Yes � No ❑ I <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Sept id- Distance from nearest well--,5O-_----Distance from foundation--.°---------------Material __:27A_f .RETI <br /> p --_- ... __ _ -----Size- _X10X__�Li uid de th----- <br /> No. of com artments_ - _ - _ q p -/!- _ Capacity----`? <br /> Disposal Field: Distance from nearest wel!_-- ---Distance from foundation....................Distance to nearest lot line----___---------- <br /> Number of lines---------Z-------------------Length of each line-_ ------ _{.N.. .Width of trench------2� '......... <br /> / . -----_ <br /> ,Type of filter materia}__._ 0_Cr___Depth of filter material-__..--I_C1_--_--___Totaf length_--------------�_-5__-.__________ <br /> Seepage Pit: Distance to nearest well---------------------Distance from foundation,------------ --._..Distance to nearest lot line----------------- <br /> ❑ Number of pits--- ------------------Lining material-.,------------------- Size: Diameter.....•. .....--.-------Depth--------------------------------- <br /> Cesspool- Distance from nearest well ----------------Distance from foundation._----- --- --- ..Lining material ._----------------.---. <br /> ❑ Size: Diameter- -. ------ ----- ----- - - _.Depth........ ------ ------------ ---------------------Liquid Capacity-- ------------------------gals. ti <br /> Privy: Distance from nearest well-------------------- --._----Distance from nearest buildingy <br /> ❑ Distance to nearest lot line .-___----------------------............____._. -4 <br /> Remodeling and/or repairing (describe)-----------------............__--_-----------_-__-----• - <br /> ------------------------- ----------------------- --•---- <br /> - --------------------------------------- -------- <br /> ----------•----------------------- - -------- <br /> -------------- ------- g-- ---------------------------- <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 /> (Signed)- ; <br /> ----------------------- <br /> ------------------ <br /> l <br /> caner and/or Contractor) <br /> Y: = Tite)--------------- ------ -- ---• --------------- <br /> (Plot <br /> plan,,showing .size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). '� 3 <br /> -' 4 OR DEPARTMENT USE ONLY \t <br /> V�! <br /> APP <br /> . ICATibN'ACCEPTED BY-------- __jL.R_.-O--------------------------- ------ DATE-- <br /> REVIEWED <br /> 9 <br /> BY------------- --------- ------------------- ----- ----------------------------------- --------------------------------- DATE <br /> -- ---._ ii <br /> BUILDING PERMIT ISSUED---- -- ---------------------- - ------------------------------------------------• ----------------- DATE f <br /> Alterations and/or recommendations------ -------------------- ----------------------------------- <br /> ---------------------------------- <br /> ------------- ----------------------------------- ..... -- . .--.... --------------- .......-------- <br /> - - ------------------------- <br /> __...--- - ------------- --------- <br /> FINAL INSPECT Date------- 49 14-- . <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Na:elton Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street <br /> Stockton,California Lodi. California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press _ <br />
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