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74-1145
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4200/4300 - Liquid Waste/Water Well Permits
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74-1145
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Entry Properties
Last modified
4/8/2019 10:08:18 PM
Creation date
12/2/2017 6:17:20 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
74-1145
STREET_NUMBER
4777
Direction
E
STREET_NAME
JAHANT
STREET_TYPE
RD
City
ACAMPO
SITE_LOCATION
4777 E JAHANT RD
RECEIVED_DATE
12/24/1974
P_LOCATION
LEON BEARDSLEY
Supplemental fields
FilePath
\MIGRATIONS\J\JAHANT\4777\74-1145.PDF
QuestysFileName
74-1145
QuestysRecordID
1799403
QuestysRecordType
12
Tags
EHD - Public
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X1,14 <br /> FOR OFFICE USE: ' i99 <br /> ................................... .. <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No. ...7`?�-�� f <br /> This Permit Expires 1 Year From Date Issued Date Issued ...IA. . Z-.731 <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/LOCATI .7. 7 <br /> .............. ... ............... CENSUS TRACT <br /> ...... . . ........: <br /> Owner's Name .. .: . . <br /> :. .. ................................................... Phone ....... .......................... <br /> Address .-1 j�........... <br /> .. ... ............... -------•... City - ............ ............... + <br /> Contractor's Name ......... . --- .... ....... ..... ^- ..............License # IY73 ? . Phone ........ .................... <br /> Installation will serve: Residence Er-A-partment House'❑ Commercial :❑Trailer Court 0 <br /> Motel ❑Other ............................................ ' <br /> Number of living units:....___.._ Number of bedrooms,�i........Garbage Grinder .............. Lot Size ....�.....f^"�°-�~�"•�........_ <br /> Water Supply: Public System and name ....................................-........... ........•........._...-.. Private �� <br /> Character of soil to a depth of 3 feet. Sand❑ Slit E] -Clay Peat C] Sandy loam C] Cloy Loam D <br /> Hardpan ❑ Adobe'd 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 /> oNEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT ( ] SEPTIC TANK kr�� Size4ya?......k....n .......... Liquid Depth ... ..�............... <br /> Capacity Type �1lx-• Material_r -�— • No. Compartments - �............� <br /> P tY Yp ----- p <br /> Distance to nearest: Well ..50'..................Foundation .... ... Prop. Line .... <br /> LEACHING LINE [� No. of Lines .......%3............. Length of each line........ Total Length .............. <br /> Box <br /> ....De Depth Filter Material ...../. .:7. -_ <br /> 'D' __1...... Type Filter Material ......:......... p ........................... <br /> Distance to nearest: Well ....... 4..I........ Foundation ........L..V,?........... Property Line <br /> ................... <br /> SEEPAGE PIT [ Depth ....._P o l- Diameter ... Number .........m5............... Rock Filled Yes .Lr No <br /> . !. .��..... <br /> ' Water Table Depth •--•---•--.r�.d. ............... --Rock Size I-VA..... <br /> ! <br /> Distance to nearest: Well ..........lip....................Foundation _j�V..._....... Prop. Line ...-...--............. <br /> REPAIR/ADDITION(Prev. Sanitation Permit#:_-• ....................................... Date ..................... ............ <br /> -Septic Tank {Specify Requirements) ....................................... ...................................................................................................... +�1 <br /> Disposal Field (Specify Requirements) ------------------------------•--• -----------------------------------..- -_-....................-----.......-----• <br /> ...............................................................................................•---...............---._...................---.............. ................... <br /> E <br /> ...................--.-----......._..................._.......----.._..---•----.._....................__....-,...._....---...._..._..._................................_...._.................._........... <br /> (Draw existing and required addition on reverse side) <br /> 1 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, I 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 r =• • --•--........ . Title .:.... <br /> .................................. <br /> I <br /> (If other than owner) <br /> -,FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ..._ _.... DATE � -.:.� `�!... 'yr............. <br /> BUILDING PERMIT ISSUED ............................ ..............DATE <br /> ADDITIONALCOMMENTS .".......... ........... ............................................... ................................................. .................................. <br /> ......------•--.....----- •. .... ----- =----------------------•----------------......----------------------...------------------------------------..._I......... <br /> ............................. ..............................I----------- ..................... ...... ..............•---•..............-•...................................... <br /> ................................ 1-41,........._........r. ........ ..... <br /> ............ .. ......................... .......... ..-. y........... s. <br /> .,..._..Date 1.._.."�'- ' <br /> Final Inspection by: .... .. °` ` :. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> CO <br /> E. H.13 241-'68 Rev. 5M -7f72 3Z <br />
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