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71-204
EnvironmentalHealth
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FARMINGTON
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4200/4300 - Liquid Waste/Water Well Permits
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71-204
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Entry Properties
Last modified
2/24/2019 10:18:01 PM
Creation date
12/5/2017 2:38:43 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
71-204
STREET_NUMBER
3602
STREET_NAME
FARMINGTON
STREET_TYPE
ROAD
SITE_LOCATION
3602 FARMINGTON
RECEIVED_DATE
03/17/1971
P_LOCATION
J W JUE
Supplemental fields
FilePath
\MIGRATIONS\F\FARMINGTON\3602\71-204.PDF
QuestysFileName
71-204
QuestysRecordID
1763424
QuestysRecordType
12
Tags
EHD - Public
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FOR OFFICE USE:------- --------------------------------------- _ <br /> APPLICATION FOR SANITATION PERMIT <br /> - ----------------------- <br /> (Complete in Triplicate) Permit No. a <br /> -------------------------- <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 tc 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 ___._ J; C� �Z / f (' <br /> -�✓'---`�O �d_. CENSUS TRACT <br /> -------------------- -------- <br /> -------------- <br /> Owner's Name ------ ' --------- <br /> -�- ----- Pha <br /> A _____________________-_______-._____ <br /> Address --.---- --- City . � <br /> --------------------------------- - <br /> T <br /> Contractor's Name ----------------------License # - <br /> ------ - ----- <br /> o�7-/-��7- -Z Phone <br /> Installation will serve: Residence ❑Apartment HouseA`Commercial ❑Trailer Court ;❑ <br /> Motel <br /> � - -------- ----------------------- --- <br /> Number of living u /� <br /> ❑ Other <br /> nits:-__'�`---__ Number of �Wz <br /> ooms __ <br /> ______Garbage Grinder _ � e3-S"� � �� <br /> Lot Size - ---------- ----- -- <br /> OV/ C --------------------- <br /> Water supply: Public System and name _______ __ � � <br /> - --- -------- - ------- -----.Private ❑ <br /> Character of soil to a depth of 3 feet: Sand [] Silt p Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe '{k 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,) <br /> PACKAGE TREATMENT { ] SEPTIC TANK f ] rr' ze <br /> -------------------- Liquid Depth ---------------- --------- O <br /> Capacity -------------------- Type -------------------- Material---------------------- No. Compartments <br /> Distance to nearest: Well ------------------------------------Foundation ----.----------------- Prop. Line .______------------... <br /> LEACHING LINE �4' No. of Lines -_._-__ __-_--__--- Length of each line__.__�{4' - <br /> '— --___.------ Total Length ----IV 6-51 _ Q, <br /> GGN <br /> 'D' Box ___ ____ _ <br /> __- Type Filter Material _�Q_cf�--Depth Filter Material .1 <br /> Foundation ____- Property Line 7---''',- <br /> - -------•-----•-•---•-- <br /> Distance to nearest: Well d�lL_ _ __CJ f <br /> - / ___-� F <br /> SEEPAGE PIT Depth _ =;57_--`"_ Diameter _ �� Number --_______l_----_____.__- Rock Filled Yes ;b' No ❑ <br /> Water Table Depth --___-__ -----_-`- <br /> ---------.Rock Size ----------r-------- <br /> Distance to nearest: Well _/V^ -j5� �e 4 4-- - ----------Foundation ---- ---- Prop. Line _..__ r <br /> ---- - -- la-___-. <br /> PAIR ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -------------------_--- <br /> Septic Tank (Specify Requirements) _________________________ - <br /> - ----------------------------------------- - <br /> Disposal Field (Specify Requirements) __-_- dJ--/ � . O ' 67 F P,4 e-hl /•-j e Z tj <br /> r , = ----------------------------------------- <br /> ` --------��. 1';------- i- ------ x_47-- -At - -a G <br /> - --------------------------------------------------- <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, 1 shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed -------------------------------------------------------- ------------------------------------ Owner <br /> By --------------- C�.c-�&�-- - �g Title ------(If other than owner) T <br /> --------- <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY _._ --_ _ _ A-- <br /> BUILDING PERMIT ISSUED DATES — � <br /> ------ <br /> ADDITIONAL COMMENTS _ - <br /> DATE <br /> ------------------------------------------------------------------------------- ----------- ------------------------------------------------------------------------------------ <br /> ---------------------------------- ---- <br /> `--------------------------------------------------------------- ------- - ------------ <br /> Final Inspection by: -__- - _--_ _�j <br />• SAN JOAQUIN LOCAL HEALTH DISTRICT --------------------------- <br /> E. H. 9 T-'6$ Rev. 5M 0, / <br />
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