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74-3
EnvironmentalHealth
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CLOVER
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10988
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4200/4300 - Liquid Waste/Water Well Permits
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74-3
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Entry Properties
Last modified
4/11/2019 10:05:49 PM
Creation date
12/4/2017 6:50:18 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
74-3
STREET_NUMBER
10988
Direction
W
STREET_NAME
CLOVER
STREET_TYPE
RD
City
TRACY
SITE_LOCATION
10988 W CLOVER RD
RECEIVED_DATE
12/28/1973
P_LOCATION
LESTER CAPPS
Supplemental fields
FilePath
\MIGRATIONS\C\CLOVER\10988\74-3.PDF
QuestysFileName
74-3
QuestysRecordID
1693609
QuestysRecordType
12
Tags
EHD - Public
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FOR OFFICE USE: <br /> w; <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No. <br /> ...7.._ ..''--�._-_-_ <br />........................................................ This Permit Expires 1 Year From Date Issued <br /> . <br /> Date Issued . y..71 <br /> Application is hereby made to the San Joaquin local Health District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ..../�../. � .Zt�- -- -:_--,/ �...........................CENSUS TRACT ................. <br /> Owner's Name ........ ..__--------- -- ------ .._.._.........Phone <br /> Address . _06 94Q _�:�L�Y_'—PIf'.C`e!9---------•----•----------•--•-•-•--------. City _.�..i!'.�_G�............:........ <br /> ............................ <br /> Contractor's Name .............014217.6.8-- -----------------------License # ..... Phone ............... •------ <br /> Installation will serve: Residence (Apartment House Commercial ❑Trailer Court C] <br /> Motel ❑ Other -.... ------•--------------------------- -- <br /> Number of living units:...�. -- Number of bedrooms -A_.-Garbage Grinder ....._..__.. Lot Size .....fp �A® ............... <br /> Water Supply: Public System and name _... -_------_---_------ --- .---._......................•-- ............ .-------.....Private ❑ I <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam El- <br /> a <br /> r Hpan ❑ Adobe 4r"Fill Material ............ If yes, type ..................... ...... <br /> {Plot plan, showing size of lot, location of system in relation to wells, buildings, 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 f ] Site----- ----- - Liquid Depth .................... <br /> ....... <br /> Capacity e -------------- Material.............._....... No. Compartments <br /> le ,00 If <br /> Distance to nearest: Well .- ---Foundation Pro Line!�P......__.__._ 1 <br /> �� p• <br /> j _... <br /> LEACHING LINE [ ] No. of Lines . �ength of each line ..... . 1.-_.. Tota! Length l <br /> -. <br /> 'D' Box .._... ... . Type Filter Material 1�-__`_�.k..Depth Filter Material _/01.--...._.......... .........•.._.. C <br /> Distance to nearest: Well ................--------_ Foundation ----------- ------------ Property Line ........................ <br /> SEEPAGE PIT [ ] Depth Diameter ----_-......... Number ........ ... ..___-_-.-- Rock Filled Yes ❑ No (:1 . <br /> Water Fable Depth ......... _ ..--- --••---Rock Size ............ ------ <br /> Distance to nearest: Well ----------------------------------------Foundation .................... Prop. Line ---................. G <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -_..................... ------------- Date ----------.-.-_--_--------.----.) , <br /> Septic Tank (Specify Requirements) ....... ......... ------------------------------------------.._._.-.-----.--------------.----------I...... <br /> Disposal Field (Specify Requirements) ----------------- --- ---------------------- ------- ---- ............_------..__.------------ •..---------.--_----------- <br /> F ........................ ...... ... -------------------------------------- ------------.----- ....-•---.... -------- ------- ......... <br /> (Draw existing and required 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 Regulations of the San Joaquin Local Health District. home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to becomp subject to Workman's Compensation laws of California." <br /> Signed ... .. ............. Owner <br /> (� - <br /> By .... _ .. ...................... -...........-................................ Title . .... .. .........-......- -...... ...........•......-......... <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .. - DATE °�Z: 8.. :7---.---•----- <br /> y BUILDING PERMIT ISSUED .- 1 . j:'. ._. . : T r .............. <br /> _ :_. <br /> ADDITIONAL COMMENTS <br /> ._...-. ... . ---- ---------------••----- ------ <br /> y. <br /> --- ----- .--- --- -- ------ -- .. <br /> Final lnspectio ----- - ------- Date .._. .._. .........,... <br /> ----------------_-----•---------- <br /> II SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> I c L 13 24 1_,An oe., rAu► 717.2 3 M <br />
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