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78-833
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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78-833
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Entry Properties
Last modified
6/16/2019 10:15:12 PM
Creation date
12/1/2017 9:47:30 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
78-833
STREET_NUMBER
24355
STREET_NAME
SKIFF
STREET_TYPE
RD
City
ESCALON
SITE_LOCATION
24355 SKIFF RD
RECEIVED_DATE
09/27/1978
P_LOCATION
LUIS DAIRY
Supplemental fields
FilePath
\MIGRATIONS\S\SKIFF\24355\78-833.PDF
QuestysFileName
78-833
QuestysRecordID
1928138
QuestysRecordType
12
Tags
EHD - Public
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FOR OFFICE USE: /__AfPLICATION,-F`OR SANITATION PERMIT FOR OFFICE USE: <br /> _.a.7.....----- .............d_ s� <br /> (Complete in Triplicate) Permit <br /> Date Issued_. ..-a `. <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 existi g Rules and Regulations: <br /> JOB ADDRESS/LOCATIO `..(�- -'---C ._/ ---------- - -------------- ....CENSUS TRACT.................... ........... <br /> Owner's Name ./_0 Phone: ' <br /> Address I ----------------,� .... .. f (/` itY---• - -------- Zip._._: : <br /> Contractor's Name...... ! _ // <br /> License #0):2 - Phone.. ._.l ._� <br /> ;�' <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> Motel ❑ Other............ ........... .......------ _ . <br /> Number of living units:._.... .:.._.Number of bedrooms.... arbage Grinder_,/V_0...Lot Size___4. .�. z --t. �_..-_............ . <br /> Water Supply: Public System[[ and name-- ...- --•--• -----:'--- ---- _....... f... ............................. Private [ ' <br /> Character of soil to a depth of 3 feet: Sand ❑ Si Clay ❑ Peat ❑ Sandy Loam [] Clay Loam ❑ ! ` <br /> Hardpan ❑ Adobe Fill Material Jf 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 pitpermitted if public sewer is available within 200.feet,) <br /> i <br /> PACKAGE TREATMENT ( j SEPTIC TANK ( ize. .........Liquid Depth. ....--.- <br /> .: Q <br /> Capacity-.� ......--__-- Type-� •_-. ...-- Material -_--� : __ !-Compartments-----I ......._._......�� <br /> Distance to nearest: Well: 6::0_..�...................Foundation.--_/_v_..f.......Prop. Line --- --LEACHING LINE LINE (t o, of Lines_.----- Length of each line------- ( C,� Total Length -- _`_-,� <br /> ( • r ' <br /> 'D' Sox.. _.. Py.�fype Filter Material.. .�_.,Depth Filter Material------....�.�.. �............................. . <br /> DistancEj nearest: Well------ /..V..-... Property Line.......... �. <br /> .-4 { /. O .....Foundation.-..:... U <br /> SEEPAGE PIT (� Depth_._• 5.---Diameter.....j.cam.... Number------------------ ---_----- Rock Filled Yes [�P✓a❑ ) <br /> .. _ --------------- <br /> '.Prop, <br /> el/ <br /> :.. ,.isWater Table Depth.--•-•-•---- -------- --------••--.Rock Size_.__.... - • - <br /> - ;..- _ '.Prop. Line..Distance to,nearest: Well----•--• oun ____S.....:.......... <br /> REPAIR/A)DITION (Prev. Sanitation Permit#-------------------------------._. --- - - Date----._.._..: :........ ....---........ <br /> r <br /> ....,� <br /> Septic Tank (Specify Requirements).................... .-- `' <br /> •-•------------- ................... <br /> Disposol'Field {Specify Requirements)_—............. ... <br /> - f <br /> ----------------------------------- ------ <br /> ------------------------------ -------------- -- ......------...... - - <br /> (Drow 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 /> Signed ......................................y <br /> By.................. �� F , •----------....._.._.....,Title........... --` <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.:. ------..DATE.-- 'a.�-..7`. <br /> ------ ------------------------------- <br /> DIVISION OF LAND NUMBER "-'--.... .._.DATE ..... -.._v... . .............. <br /> ADDITIONAL COMMENTS_._.. . .7/�.... _ . .- ryf.f - P`�� lCG.�.ha._!� <br /> / -'- <br /> � .. _ -.. '-. .. _ - -------- ------------------- <br /> -- <br /> -------------------------- <br /> -------- - <br /> Final-Inspection bY:--- �` ... . ----------------------- .•---------.... --- -------- ---Date.-- a2�..7� <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 REV. 7 7 <br />
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