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78-280
EnvironmentalHealth
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KASSON
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1B127
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4200/4300 - Liquid Waste/Water Well Permits
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78-280
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Entry Properties
Last modified
6/9/2019 10:11:52 PM
Creation date
12/2/2017 7:06:59 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
78-280
PE
4211
STREET_NUMBER
1B127
STREET_NAME
REDWOOD
City
TRACY
SITE_LOCATION
30000 KASSON RD - 1B127 REDWOOD
RECEIVED_DATE
5/2/1978
P_LOCATION
FERRERA
Supplemental fields
FilePath
\MIGRATIONS\K\KASSON\30000\REDWOOD\1B127\78-280.PDF
QuestysRecordID
1802677
Tags
EHD - Public
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FOR OFFICE USE: ,/ FOR OFFICE USE: <br /> v APPLICATIOP FOR-KANITATION PERMIT <br /> ----------------------- ------- -------- ---- ---- �k-.,:2 <br /> ,� � f (Complete in Triplicate) Permit No....................... <br /> --------------------- ----------- - -- ------------__ ` Date Issued - <br /> 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 described. <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION 3GS a .. - Ass R°r 7R-Ac CENSUS TRACT.. <br /> Owner's Name---01�6.*.1�'j- .._.. Lc 1Q.A.. _---- ------ ------- ------------- <br /> ------ ------Phone------- ----------- <br /> ZiAddress . . Sh � �* , <br /> Contractor's Name_ <br /> ---- --------.-._License #_�33`j5-.�.5-- -Phone.-P. -. ,I`'.- <br /> t <br /> Installation will serve: sidence Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> t Motel ❑ Other -- ...----- ------- --------------------- <br /> Number of living units:._./...--.------Number of bedrooms....,....Garbage Grinder--I_-....Lot Size.-4C-n. _.k.J -------- <br /> Water <br /> - :---.Water Supply: Public System and name..__- ------ ................ -----------------------Private <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ® Clay Loam E)Hardpan E) Adobe❑ Fill Material.- ----_...If yes, type--------------------------- <br /> _-_ <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 -..._-,ADO._.JZt— ...... Liquid Depth---- -------------------� <br /> Capacity..-ZOO Q_�1-Type.-.C&-r.L. M.4 -.Material--__--_•------------------No. Compartments.......... -i-----------•-••--� <br /> Distance to nearest: Well..........------V4--._.-______---Foundation....LD�+K�'1.-A.-. Prop. Line_- 17- '!'<<.`-!----... <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 O Depth------------ ._Diameter----- -..Number----.--------------------- ----- Rock Filled Yes ❑ No ❑ <br /> WaterTable Depth.------------------- ............ -------------------Rock Size-----................ --------- ---------------- <br /> Distance <br /> ------- --Distance to nearest: Well...........................................Foundation.--.-.__-..__..._-....._.Prop. Line_-----.---------._--- <br /> REPAIR/ADDITION (Prev. Sanitation Permit#.-.-_--_------.--_-___----_ --- . C <br /> .- ---------Date------------------ -- -- --- -- ----------) <br /> Septic Tank (Specify Requirements)-------- -_-__ --------- -- ----------c <br /> - n <br /> Disposal Field (Specify Requirements)_._._0...)4-,Zt7-----__-F1.�. ._-G�..,. -. <br /> - ........... <br /> ........... -------------------------•------------- -------------- ----------••----------------------- .......................... ------------------------ ----- -----....------- ------ <br /> (Draw 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 Owner /� _ <br /> By........ _-- ..... -- --------- --- -- ---------------- - ----.-..._.Title--- ---- �^-- <br /> (If er than n <br /> FOR DEP <br /> A TMENT USE ONLY <br /> APPLICATION ACCEPTED BY------ 1 - <br /> .---------•-------------------- -DATE_..._.S - --. .Z$.._.-._- ---- <br /> ----- -- - ---- ----- <br /> DIVISION OF LAND NUMBER..- -- -- . -------__---------- DATE..... ---------- - ---- - ---- - <br /> ADDITIONAL COMMENTS............. ......... <br /> -------------- --------- -------- ----------- ------------ -----•------.-...---------------- ---- ----------------- •---.---- ---------- -- -- - -----------------•----------- --,---....--- --..-- ---- <br /> ............................................... ... ----- ----- ........ ----- ------ - ------•------------ - . -- .. <br /> --•---------•..... - �- <br /> f _ _ -- - -- <br /> - - ---- - ------ = - - <br /> c''�' Date - -� <br /> erg - • ---- •- --- --•-----• •--•- <br /> Final Inspection by: --- - :- . - Z't--- -- --- ---- --- 1677 - <br /> €H 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT / S 21677 REV. 7/76 3M <br />
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