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72-908
EnvironmentalHealth
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GROVE TREE
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4200/4300 - Liquid Waste/Water Well Permits
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72-908
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Entry Properties
Last modified
3/26/2019 10:06:18 PM
Creation date
12/2/2017 1:45:46 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
72-908
STREET_NUMBER
8501
Direction
S
STREET_NAME
GROVE TREE
STREET_TYPE
RD
City
FRENCH CAMP
SITE_LOCATION
8501 S GROVE TREE RD
RECEIVED_DATE
09/15/1972
P_LOCATION
JAIME AMADO
Supplemental fields
FilePath
\MIGRATIONS\G\GROVETREE\8501\72-908.PDF
QuestysFileName
72-908
QuestysRecordID
1792513
QuestysRecordType
12
Tags
EHD - Public
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F8R OFFICE USE: APPLICATIOW ,I=OR SANITATION -PERMIT p <br /> _t---- <br /> Permit No-- . <br /> ------------ <br /> (Complete in Triplicate) _ <br /> -------------------------------------------------------- <br /> Date;. Issued ----------5-'-7.2_--;. <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 <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> p <br /> 6U�-----'P,, <br /> — ---- CENSUS TRACT -------------_------------ <br /> JOB <br /> ADDRESS/LOCATION L ti <br /> Phone Owner's Name .------------T-A-lAt�------- ----------- <br /> _k67 <br /> --------- <br /> _k6Address ---------- ------- d s 'U city ----F <br /> Contractor's Name License #a.7��ZPhone _ems!-= <br /> Installation will serve: Residence M-K-Partment House❑ Commercial:❑Trailer Court i❑ ; <br /> Motel ❑Other ------------------------------------ -- --- <br /> Number of living units:-.--t------ Number of bedrooms -3-------Garbage Grinder -___-----_- Lot Size{ __�`-v G ---�� �-- <br /> Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Private <br /> ----------------------------- -------------------------------------------------------------------------------Private <br /> Character of soil to a depth of 3 feet. Sand''Silt❑ Clay ❑ Peat❑ Sandy Loam E] Clay Loam.❑ <br /> Hardpan ❑ Adobe '❑ Fill Material_ If yestype <br /> i <br /> lPlot plan, showing size of lot, location of system in relation to wells, buildings, etc. must"be placed on reverse side.] 1) <br /> NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT ] SEPTIC TANK'[ ] Size -6 A- .)K---<----------------------- Liquid Depth - G----_---..--- ---- <br /> Capacity I rV__._. Type E f Material---------------------- No. Compartments <br /> Distance to nearest: Well ----56-,--e-------------------Foundation —--------------- Prop. Line __6------------- <br /> 40 <br /> --_-.----- -. <br /> LEACHING LINE ] No. of Lines _.__ - Length of each line------7a------- Total Length ___r ... ------ <br /> [ g <br /> 'D' Box ._/------- Type Filter Material d - -.Depth Filter Material ------ ---------------------- ....... <br /> Distance to nearest: Well 4�_C___"------- Foundation .`b--f-------.-- Property Line ---s�----------------- <br /> SEEPAGE <br /> ---—---------- <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number -------- ------------------- Rock Filled Yes ❑ ,.No ❑ <br /> WaterTable Depth -------------------------------------------------Rock Size -------------------------------- <br /> Distance to nearest; Well ----------------------------------------Foundation -------------------- Prop. Line ...------------------- <br /> REPAIRJADDITION(Pfev. Sanitation Permit# -------------------------------------------- Date ---------------------------------- -----------) <br /> Septic Tank (Specify Requirements) -------- ---------------------------------------------------------------------g- ------- ------------------------------- <br /> Disposal Field (Specify Requirements) ----------- ----------------------------------------------------------------------------------------------------- <br /> - ----------------------------------------------------------------- <br /> ------------------ -- ------------- ------- ---------------------------------------------------------------------------=------------------------------------------- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have preparid 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 su lett t a� nan's Compensation laws of California." <br /> Signed -------- ` 4---- -- - ---- -------------------------------------------- Owner <br /> B ---------------- ----------- Title -------- -- ------------------------------------ ---------------------- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .. .... -----------------. DATE ---.- �-.lr- -- <br /> ] BUILDING PERMIT,ISSUED --------------------------------------------- <br /> -- ----DATE ------------------------------------------- <br /> ADDITIONALCOMMENTS ----------------------------- ------------------------------ ----------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------- <br /> ------------- ----------------------------------------------------------'---------------------------------------------=---------------------------- ---------------------------------------- <br /> --- ---- ---- <br /> ----- <br /> Final Inspection by ----------- - r=------------------------------------------- -----------Date --- --- <br /> SAN <br /> -SAN JOA UIN LOCAL HEALTH DISTRICT M <br /> I r . <br /> S _ ' <br /> E. H. 9 1-'68 Rev. 5M. <br />
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