My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
77-910
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
E
>
ELLIOTT
>
26392
>
4200/4300 - Liquid Waste/Water Well Permits
>
77-910
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
6/1/2019 10:17:45 PM
Creation date
12/5/2017 12:59:59 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
77-910
STREET_NUMBER
26392
Direction
N
STREET_NAME
ELLIOTT
STREET_TYPE
RD
City
GALT
SITE_LOCATION
26392 N ELLIOTT RD
RECEIVED_DATE
11/14/1977
P_LOCATION
JOHN TOLEDO
Supplemental fields
FilePath
\MIGRATIONS\E\ELLIOTT\26392\77-910.PDF
QuestysFileName
77-910
QuestysRecordID
1730764
QuestysRecordType
12
Tags
EHD - Public
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
2
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> -------------------------- ---------- 77 See <br /> --- --------- - {Complete in Triplicate) Permit No.___.____. __._______. <br /> --------------------------------------------------------- 11-15-- 7,7 <br /> Date Issued----------------- <br /> -------------------------------------------------- _____ This Permit Expires 1 Year From 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/LO TION.-_�-. .., -2-------11--- -v ------------------------------------------------CENSUS TRACT--------------------------------- <br /> Owner's Name.. �a ----------------- ------ Phone---------------------------- <br /> -g C.>� ----------City ---------------------zip----------------------------- <br /> Address--------------------- <br /> Contractor's Name---- ;n---------- - -. - ...License #---3Z�Zz Phone_--------------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> Motel ❑ Other-------- ------------------------------------- <br /> Number of living units________ ________Number of bedrooms_--_y_.Garbage Grinder------------Lot Size--- — --------- .__.__.--._---._._-.--- <br /> Water Supply: Public System and name------------------ ----Private <br /> - -------------------------------------------------------------------------------------------------------- -- <br /> Character of soil to a depth of 3 fe�XAclobe <br /> Sand ❑ Silt E] Clay E] Peat ❑ Sandy Loam ❑ Clay Loam E]Hardpan ❑ 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 flank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT, ,[ ] SEPTIC TANK L J ,., Size--____--.-_ ---------------------------Liquid Depth %Y <br /> . 4 . <br /> lN <br /> Capacity------------;--L---{.Type- �-----------------Material--------------------------No. Compartments------------------ ---------------- <br /> Distance to nearest: Well----------------------------- ------Foundation--------------------------Prop. Line---------------------------. <br /> LEACHING LINE [ ] No. of Lines-----------------------------Length of each4ih5---_.:. ---------------------Total Length.------------------------------------ -- <br /> D' Box............Type Filter Material-------`-` ---=Depth Filter NCaterial---------------------------------------------------------------.- <br /> Distanca to nearest: Well----------------------------Foundation-----------------------------Property Line------------------------------------ <br /> I <br /> SEEPAGE PIT [ ] Depth----------------Diameter--------------------Number------------------------------_. Rock Filled Yes ❑ No ❑� <br /> WaterTable Depth------------------------------------------------------- Rock Size.----------------------------------------------- t. <br /> Distance to nearest: Weil---------------_--..--------.-------------Foundation------------------ ------ Prop. Line------------------ <br /> REPAIR/ADDITION (Prev. Sanitation Permit#---------------------------------------------------Date----------------------------------------------f <br /> Septic Tank (Specify Requirements)------ ---------------------------------------------------------------------- --- _^ <br /> Dis I Field pecify Requirements)---- ---- -- ----------- ------ f `' !`X''`--------------------------------- <br /> --------- ------------------ <br /> -Z «X Z- - ---------------- ------------------------------------------------ ---------------- f <br /> { w existing and required addition on reverse side) <br /> 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 o]Workman's Compensation laws of California." <br /> Signed------------- 11 ----..-. -------- ---- ------------------------Owner <br /> _ <br /> By-------------------- ----------------------------- --------- --- - -----Title- <br /> ------------------ - <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -"� 4• -------------------- DATE. <br /> DIVISION OF LAND NUMBER--------------------- ------ ------------- ---------------------DATE ----------------- <br /> ADDITIONAL COMMENTS----------------- ------------------------- ------------------------------------------------------------------ ----------------------------- <br /> --------------------- ------------------------------------------------•------------------- <br /> ----------------------------------------------- ----------- ------------------------------ <br /> ------ -- -- --- - -------------------------------------------- <br /> ---- <br /> - - - - - ---- ------/--- -- - ---- <br /> Final Inspection by------- ----- - -4------ ------ - - -- ---- - Date/ ! r <br /> ---------------------------- - - -- -- - - <br /> ------ ------ - <br /> FH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT FBS 21677 REV. 7176 3M <br />
The URL can be used to link to this page
Your browser does not support the video tag.