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SR0084381
Environmental Health - Public
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4200/4300 - Liquid Waste/Water Well Permits
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SR0084381
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Last modified
12/22/2021 1:39:12 PM
Creation date
12/22/2021 1:25:52 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
SR0084381
PE
4202
STREET_NUMBER
11268
Direction
E
STREET_NAME
MARIPOSA
STREET_TYPE
RD
City
STOCKTON
Zip
95215
APN
18106016
ENTERED_DATE
10/21/2021 12:00:00 AM
SITE_LOCATION
11268 E MARIPOSA RD
P_LOCATION
99
P_DISTRICT
001
QC Status
Approved
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EHD - Public
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' '~~~''~^~~^ <br />' FOR SANITATION <br />� ���8� <br />`~�—�--�-�— <br />�� c Ponn|�No�� <br />�I ���nnA��|nT�»��«mm� <br />°"^=" r <br />.................... -- i, This Permit Expires I Year From Date Issued Date Issued � <br />` <br />Application is hereby made to the San Joaquin Local Health District for n permit to construct and \nmoU the work herein <br />Hardpandescribed. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br />A.......... <br />Installation will serve: Residence j>(Apartment House -0 Commerciol:E]Trailer Court 0 <br />Number of living units:_/_.. Number of bedrooms '___:�!�arbage Grinder ............ Lot Size ------------ <br />Character of soil to a depth of 3 feet: Sand[] Silto Clay E] Peat F1_SYn7j- =om EJCldTLZi66i-.0 <br />Adobe Fill Material R yes tyloe <br />(Plot plan, showing size of lot, location of systeTh-i�-relZiflun-tu-Wel I s-, build i ngs;-etc;-- must -be-placed -on -reverse-� side.) <br />NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) I <br />PACKAGE TREATMENT -SEPTIC TANK I pth -----_----_-- <br />Distance. fro near�est: Well -- -------------------- Foundation . .. .. .......... Prop. Line ........... ........... <br />qz <br />(Draw existing �d�� uired addition on reverse side) <br />I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br />County Ordinances, State Laws' and Rules and Rogulafions of the Son Joaquin Local He % - �,i -I , 1 11 <br />sed agents signature certifies the f allowing: --1 11 _J 0 :1 IV -:11 <br />"I certify that in the performance.of the "or "id'r-whiih this permit Is Issued, I shall not employ any person Jn suc mainner <br />as to become subject to Workman's Compensation laws'af California." <Aj <br />| � <br />o� <br />'' ^ FOR DEPAitTMENT USE ONLY <br />"',"CA""'` "CC^''E" BY '~"'��....... ----------`-----' ---y''^'-r--�'-'-' <br />BUILDING PERMIT BSUED--_--''��.—'�-_-��_-----_---.--_---DATE ----___'---_ <br />ADDITIONAL COMMENTS --_-_-____---_'-_-------'--------'---'---`---'--- <br />" '----_--''.__.---'—'---_'''---_'_-- <br />--'----_'--------_-------_--_--. <br />---------- "' -----'---'------'-----'—''--'—'-���zz'�' <br />/ <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />� <br />E H. 9 1''68 Rev. 5M / <br />
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