My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
79-491
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
K
>
KASSON
>
30000
>
FRIANT
>
2K019
>
4200/4300 - Liquid Waste/Water Well Permits
>
79-491
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
6/24/2019 10:59:57 PM
Creation date
12/2/2017 6:57:27 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
79-491
PE
4211
STREET_NUMBER
2K019
STREET_NAME
FRIANT
City
TRACY
SITE_LOCATION
30000 KASSON RD - 2K019 FRIANT
RECEIVED_DATE
06/07/1979
P_LOCATION
W O DAVIS
Supplemental fields
FilePath
\MIGRATIONS\K\KASSON\30000\FRIANT\2K019\79-491.PDF
QuestysRecordID
1804437
Tags
EHD - Public
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
2
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
FOR OFFICE USE: l�-o E FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> l-} Z (Complete in Triplicate)' Permit No....................... <br /> Date Issued_ <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 existing Rules and Regulations: <br /> A <br /> Ao7" Fa-i.4ivT 5T, <br /> JOB ADDRESS/LOCATION ........_Sw , Q.A.B....ti._ j- vey__GGvG ------- ------CENSUS TRACT. <br /> Owner's Name -- .. -.W,.e!�. ... .... .... ..... ------ .-----.._..------------------..Phone:--------------•-----..------------Address-------3o COO.._XA.fSc�M...`�c1........ .... <br /> --.''..Zip_ <br /> - --- --- Y <br /> Contractor's Name.--- - H.......... -------- . ....... License #..�66 S8`-. ---_Phone. <br /> Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> Motel ❑ Other_.._- ------------- ---------_------- <br /> Number of living units:__. ........Number of bedrooms.... Garbage Grinder_.........Lot Size...._-��+0'X/bb.. <br /> Water Supply: Public System and name.. R C, Private El <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ 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 [ ] Size------ ------------------------------------------------.Liquid Depth---------- <br /> Capacity-/,?. 0-------.__Type.1005T <br /> .__:__...Capacity- •TOO---------TYPe-O.vr 4r4Xr. Material.....GO/YC.........No. Compartments----- .----••-----.----- <br /> Distance to nearest: Well..............___. .. _____---...Foundation... ------ 1.... .... ._Prop. Line.__e0.--._._._...-.._. <br /> [ J No. of Lines . ........:................Length of each line.. o�X. G'.._.._. Total Length .. `���._S --------------------- <br /> 1'7T. <br /> F'/4 'D' Box---/ ......Type Filter Material.. 4--<N ....Depth Filter Material_._ . ........._-...-.----...........-..........F... <br /> Distance to nearest: Well---------------._---------- Foundation._.- ------------------ ...Property Line...--------------.___..__.._-_Q <br /> SEEPAGE PIT [ ] Depth.._------__.._Diameter_ ............_....Number------________________.--_--. Rock Filled Yes ❑ No� <br /> Water Table Depth.............. .............. - _.................Rock Size------- -_ ._ ------------_----•---------- <br /> Distance to nearest: Well.----------------..---------------- ..._...Foundation................... _ ---Prop. Line---.---------------__- <br /> REPAIR/ADDITION (Prev. Sanitation Permit#..._.._....._.-_..,.__.......... ...............Date........__...._.._.._.-__..------.---.--..) <br /> Septic Tank (Specify Requirements)------- ----•---- ----- ----------------- -------------------- ----- -- <br /> Disposal Field (Specify Requirements) -----........,._..,.. <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 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, 1 shall not employ any person in such manner as <br /> to become subject to Workman's Compensation laws of California." <br /> Signed F" A V74!4 /r ve sOy <br /> - ----- - - - ----------------------------------.-....----------- --------Owner <br /> By..-------- ------ Title-.------------ ---------------- ------ <br /> other than owner) <br /> OR ENT USE ONLY <br /> APPLICATION ACCEPTED BY .. - - DATE .._._�.-_�p-_7��. - <br /> DIVISION OF LAND NUMBE . - DATE <br /> ADDITIONAL COMMENTS--- -------------------- -------------•------ ... <br /> --- . `� � �- -sem - ... <br /> - <br /> _ ----- <br /> .......--------•--------------------- -- -:.- . ......... <br /> ..._...-----•---- -------------------------- --- - ---..._ -- ..- ---------- <br /> FinalInspection by:.......... - ------ --- -------------_-----------_ ------------------------------------------------------------Date------....... -------- -- ---------------- ----- <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/76 3M <br /> C <br />
The URL can be used to link to this page
Your browser does not support the video tag.