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78-1017
EnvironmentalHealth
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DURHAM FERRY
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4200/4300 - Liquid Waste/Water Well Permits
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78-1017
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Last modified
6/3/2019 10:07:40 PM
Creation date
12/4/2017 10:44:36 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
78-1017
STREET_NUMBER
294
Direction
W
STREET_NAME
DURHAMA FERRY
STREET_TYPE
RD
SITE_LOCATION
294 W DURHAM FERRY RD
RECEIVED_DATE
11/07/1978
P_LOCATION
TED BOGETTI
Supplemental fields
FilePath
\MIGRATIONS\D\DURHAM FERRY\294\78-1017.PDF
QuestysFileName
78-1017
QuestysRecordID
1719060
QuestysRecordType
12
Tags
EHD - Public
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FOR OFFICE USE: <br /> _ V/""` FOR OFFICE USE; <br /> APPLICATIQN FOR SANITATION PERMIT <br /> - ----------- (Completei1t-4-iplicate) Permit <br /> This Permit Expires 1 Year From Date Issued Date Issued <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 application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION..----�.9-�f .._. :-.../✓v�r�—` •�# /.. E'TY .....------ .CENSUS TRACT.....-.. ............. <br /> Owner's Name. ` � .. f�d 'Q.T/.-./...........---------------------- ----------------------------------------Phone......................... ...... <br /> Address....-- ��.M e-------- . --------- ----- -- ... .. _...Cit 7�/5R G Zi <br /> Contractor's Name �.�7.LV ...'W//- -------- ..... Phone.... <br /> License #--�.-- - <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> Motel ❑ Other--------------------------------------- ----- �j ,( <br /> Number of living units;...../---------Number of bedrooms----�7-�. Garbage Grinder--------....Lot Size.-,Aloh"Cl,�. ......................... ..... . <br /> Water Supply: Public System and name.. ........... --•- ---...-.-.-..---.-------------------------Private <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam iR <br /> Hardpan ❑ Adobe ❑ Fill Material . .... ....If yes, type---------------------------- <br /> Mot <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,) <br /> PACKAGE TREATMENT _ --------------------------....Liquid Depth.----------- <br /> ' <br /> l SEPTIC TANK [ ] Size :..... ...................•- <br /> Capacity.���e 0'00 yp OJ'N,CIA$ Compartments.__:-..-_., <br /> .-----T e------ ---- - ------Material... li�G..�_....No. ...---- <br /> Distance to nearest; Well---.------ .........Foundation....fd ..- Prop. Line...^��-d...__...... <br /> LEACHING LINE y---------------Length of each line...: ---.--------- --- Total Length .. <br /> [ ] No. of Lines . ___ _.... <br /> I/ <br /> 'D' <br /> 'D' Box..... ..Type Filter Material ... Depth Filter Material....-'30--- G <br /> Distance to nearest: Well------ .............Foundation.....-3-------- ____ -Property Line------------------. <br /> SEEPAGE PIT f ] Depth.......... .....Diameter-------------_......Number._ ------ --------------------- Rock Filled Yes ❑ No <br /> Water Table Depth------------------------------ ------------ ---------Rock Size.............. ---------------- <br /> Distance to nearest: Well-------------------------------------------Foundation.-.-............ .. ......Prop. Line..-.---------.-----.-.----- <br /> REPAIR/ADDITION (Prev. Sanitation Permit#----------------------------------- --- ----Date-------------- -------.-------.. _-- -- - -) <br /> Septic Tank (Specify Requirements). -• . --- ----- -- -------------------- ... ----- .. <br /> Disposal Field (Specify Requirements) - ------ ------------- <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 County <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents <br /> 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 as <br /> to become subject to Workman's Compensation laws of California." <br /> C]. ¢ 54 <br /> Signed......... .. . . ..T -- -.....-- -./y . .-- ..- --.".--Owner <br /> - - <br /> By.......... -------- --- - --- Title--- -- ------- -- <br /> (If o er an owner} <br /> FOR DEPART ENT USE ONLY <br /> APPLICATION ACCEPTED BY---- ----..DATE ----- <br /> DIVISION <br /> ---DIVISION OF LAND NUMBER._............ ........ ------ DATE......-.-----------. ............ <br /> ADDITIONAL COMMENTS ---- - - ....... <br /> -------------------- .......... <br /> -- -------- ----- <br /> Final Inspection b ----------------- ---------Dat -- f <br /> y:.......... �/ - � ... <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 RRE�v. _7/76 3M <br />
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