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73-927
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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73-927
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Entry Properties
Last modified
4/7/2019 10:06:29 PM
Creation date
12/5/2017 1:43:12 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
73-927
STREET_NUMBER
2365
Direction
E
STREET_NAME
EUCLID
SITE_LOCATION
2365 E EUCLID
RECEIVED_DATE
10/5/1973
P_LOCATION
NORMAN J MULLHOLLAND
Supplemental fields
FilePath
\MIGRATIONS\E\EUCLID\2365\73-927.PDF
QuestysFileName
73-927
QuestysRecordID
1733897
QuestysRecordType
12
Tags
EHD - Public
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FOR 07f ICE USE. APPLICATION FOR SANITATION PERMIT <br /> yf . <br /> {Complete in Triplicate) <br /> This Permit Expires 1 Year From Date Issued Date Issued .ham.•-- - <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 . •----!�-- ��.-- .......6_ -L-t Q.............. .... .... ...............CENSUS TRACT .......................... <br /> Owner's Name ----........ .r_!M. . ....... :0....1.` .5. ,.. . ... 'fit�t�f�¢ N... ..................................Phone .. �D -_�.r .Q ..... <br /> Address .... ......:...... R.`�-'�.c�. ' City •----•--•-•-. ....... <br /> Contractor's Name .. .--. ... .,.... ...C10.F-( t1F... - Y +-----------------license # .c1J` ? .. Phone ?-� <br /> Installation will serve: Residence KApartment House Commercial ❑Trailer Court 0 <br /> Motel ❑ Other ........:..............•-----------. •. <br /> Number of living units:.. ._.. . Number of bedrooms �--_-_Garbage Grinder . ._ Lot Size ....Ihsx ......... <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 ❑ <br /> Hardpan ❑ Adobe 19 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 permittee( if public sewer is available within 200 feet,) � <br /> PACKAGE TREATMENT [ ] SEPTIC TANK-f _ Size........................................... Liquid Depth .......................... 6 <br /> Capacity .. Type ----- -------------- Material---- _.. No. Compartments ................_..... Ul <br /> Distance to nearest: Well ........Foundation ..... ................ Prop, Line ......- ............. <br /> LEACHING LINE [ ] No, of Lines - .. Length of each line ........ .. ... .. ...... Total Length <br /> 'D' Box .... . . Type Filter Material --------------- ----Depth Filter Material -------- <br /> Distance to nearest: Well ........................ Foundation .....__. ............. Property Line .................-------rn <br /> SEEPAGE PIT [ ] Depth Diameter ----------- Number . .... .. .............. Rock Filled Yes ❑ No ip0 <br /> Water Table Depth ------ -----------------------------------------Rock Size . -_--- r <br /> Distance to nearest: Well ----------------------------------------Foundation .................... Prop. Line .................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ........ ............ ..................... Date --_------------_---------- <br /> Septic <br /> -._--_---.._--._.-..----Septic Tank {Specify Requirements) ...... .......•• <br /> Disposal Field (Specify Requirements) ----------- ; <br /> . ... . ... ........... <br /> ................ ..... ......... ...................................................... .......... .......... ---------------------------------- ................... .................. <br /> - <br /> (Draw 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 <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licew <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, I shell not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed .... . ............. ... Owner <br /> ....._ Title .... . ... ............................ <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY _ <br /> APPLICATION ACCEPTED BY ....... ........... _ DATE .... <br /> BUILDING PERMIT ISSUED .... f <br /> ...-.._. .. .. _. ...../.._.--- . .. . ._DATE - -------•-- <br /> ADDITIONALCOMMENTS .. . ...................... .......__ -•---•- .----------------I.... ....._......................................... -------------------------- <br /> ------------------- <br /> ------------------ .............................................................. ..... •------•- ............................ ............................. <br /> ------------ --------------- - ------•--- .--•-- ._.......--•- .... f <br /> Final Inspection by: ...A -------Date ..._� __.�l/� ........ <br /> 3• <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 0 <br /> E. H. 13 24 1-'68 Rev. SM 7/72 3 m <br />
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