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72-359
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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WOODSON
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3221
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4200/4300 - Liquid Waste/Water Well Permits
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72-359
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Entry Properties
Last modified
3/20/2019 10:06:04 PM
Creation date
12/1/2017 2:31:38 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
72-359
STREET_NUMBER
3221
Direction
E
STREET_NAME
WOODSON
STREET_TYPE
RD
City
ACAMPO
SITE_LOCATION
3221 E WOODSON RD
RECEIVED_DATE
04/03/1972
P_LOCATION
AL QUASHNICK
Supplemental fields
FilePath
\MIGRATIONS\W\WOODSON\3221\72-359.PDF
QuestysFileName
72-359
QuestysRecordID
1992983
QuestysRecordType
12
Tags
EHD - Public
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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ------------------------------------ -------------------- Permit No. <br /> (Complete in Triplicate) �" <br /> ---------------------------------------------------------- <br /> --------- ----------------------------------------------- This Permit Expires 1 Year From Date Issued <br /> Date Issued <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 .-- - Z� CENSUS TRACT s '---------------- <br /> Owner's Name -----)ZA.;--- �:.� '/7 Phone ,��_" � <br /> - _��4-2'- <br /> Address �� Citr ��' <br /> - Y _ ... . <br /> Contractor's Name ------ !�- _ __ ---- -.License# Phone <br /> Installation will serve: Reside e ❑Apartment House] Commercial ❑Trailer <br /> Motel Other -------------- -------------------------- <br /> Number of living units:______ Number of bedrooms .- _____Garbage Grinder -__a_-- Lot Size o'L_.4 c_ __ <br /> _ --------------- <br /> Water Supply. Public System and name ---------------------------------------------------------------------------------------------------------------Private <br /> Character of soil to a depth of 3 feet: Sand'❑. Silt E] Clay : Peat❑ Sandy Loam C❑ Clay Loam:❑' <br /> Hardpan ❑ Adobe'❑ 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 1 1 Size------------------------------------------------ Liquid Depth ----------------•--------- <br /> Capacity ----- ------------- Type -------------------- Material------------- ------ No. Compartments -------------------..- <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 ------------._____-_____ <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No I❑ <br /> Water Table Depth ------------------------------------------------Rock Size -------------------------------- <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line .......-............ <br /> -- <br /> REPAIR/ADDITION(Prev. Sanitation Permit#,-------------------------------------------- bate ---------------------------------_) <br /> Septic Tank (Specify Requirements) -------- ---- -------------------- •---------- ---- ------------- <br /> Disposal Fi Id (Specify Requirements) <br /> VV <br /> -- --------------------------------------------------------- <br /> (Draw exists 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 Son 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 become subject to Workman's Compensation laws of California." <br /> Signer! --------------------------- ---- --------------------------------------------------------•-- Owner <br /> BY ------------- Title -��u <br /> f - <br /> -------------- --------------- <br /> ----------------- <br /> o#her n owners <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - DATE ---�— <br /> BUILDING PERMIT ISSUED ------------------ _DATE ---------- ----- <br /> -------------=------------------------------------------------------------------------- --------------------- <br /> ADDITIONALCOMMENTS --------------------------------------- ------------------------- --------- ------------------------------------------------------ --------------------------- <br /> ------- ------------------------------------------------------ -=------------------------------------------------ ------------------------------------------------------------------------- <br /> t <br /> ---------------------------------- ---- ----------- ---------------- ---- - - --- <br /> Final Inspection by: ------------------------------------------------------------- ----------Date -.77 - _r---_v_' --- <br /> SAN JOAOUIN LOCAL HEALTH DISTRICT <br /> E. 1-'68 Rev. 5M <br /> y._ <br />
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