My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
72-849
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
K
>
KOFTINOW
>
7838
>
4200/4300 - Liquid Waste/Water Well Permits
>
72-849
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
3/26/2019 10:04:53 PM
Creation date
12/2/2017 8:00:12 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
72-849
STREET_NUMBER
7838
STREET_NAME
KOFTINOW
STREET_TYPE
CT
City
MANTECA
SITE_LOCATION
7838 KOFTINOW CT
RECEIVED_DATE
08/17/1972
P_LOCATION
MANUEL SOUSA
Supplemental fields
FilePath
\MIGRATIONS\K\KOFTINOW\7838\72-849.PDF
QuestysFileName
72-849
QuestysRecordID
1810647
QuestysRecordType
12
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
View images
View plain text
FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> 7--------- -- -------- ,. -, I " <br /> ---------------------------- ;i,' ' ' Permit it <br /> -------- 1--------- ------------------------------------ 71 <br /> Date Issued <br /> ------------ ---------------------------------------------- 161-11his Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for 0 permit to constructcind install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existinV-Rules and Regulations- <br /> JOB ADDRESS/LOCATION :M-3 ------ - ------__._ ___..._CE_N§0S_TRACT ------- <br /> Owner's Name - -------M_&-N__V_F—__L-- ---------- ---Phone i__923__-_2_5,3_'7------ <br /> Address -----6_01------_DlAtvl ------Diz <br /> ------------------------------------. City---- ----------- <br /> Contractor's Name 52E�X41_CZ_._.License # 2&514-77 -_ Phone <br /> I Al. <br /> Installation will serve: Residence ErA`p`a`rtment House E] Commercial :❑Trailer Court in <br /> Motel F-1 Other ----------------- --------------------------- <br /> Number of living units:----- ----- Number of bedrooms ---3-----Garbc!ge Grincle>r>.�-S_,.Lot Size ---------------------------------- <br /> Water Supply: Public System and name ---------------------------------------=--------------------- --------- ---- -- ---------Private El <br /> Character of soil to a depth of 3 feet: Sand'o Silt 0 Clay E] Peat E] Sandy-Loam Clay Loom ❑ <br /> ardpan ❑EJ ❑Adobe-E] Fill M'aierial:�---------- 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 seep it permitted if public sewer is available within 200 feet,)PACKAGE TREATMENT SEPTIC TANK'[ S i ze'_//)( -lx__.. ------------- Liquid Depth ----------------- <br /> Capacity TypelPFIEC-A-5 aterial0_A- KK,_V777 <br /> N0.; Compartments ----Z----- ....... <br /> 0---------------------- <br /> istance to near----2 Well 'FfGndc;tion'i_"_ a Prop, Line ----5----7f7i <br /> 0 <br /> LEACHING LINE. E/No. of Lines -- ------- Length of <br /> each ----- Total Lenth _-_A6 -1.......... <br /> V Box/M5_ Type Filter Material Depth Filter' Material ---------/7---11----------i------------ <br /> -4- <br /> is I -i <br /> D tance to''nearest: Well ---- ---------- Fouridation ----14? ---- Property Line _-_,5..�` <br /> Rock Filled Yes <br /> SEEPAGE PIT Depth _,/l------------- Diameter NumbeT -------- <br /> Water Tab[(! Depth -----4—-1 <br /> ---------- ------------------------Rock Size ------------------ -------- <br /> Distance fd4fi`Zarest. We'll --------________________Foundation -------------------- Prop. Line ......... . <br /> I -- ---------- -------- <br /> REPAIR/ADDITION(Prev. Sanitation Permif# ------I- ------------------- ------- Date ----------------------------------) 4 <br /> Septic Tank (Specify Requirements) ------ <br /> -----------z-------=--------------------------------- --------------------------------------------------------- <br /> Disposal Field (Specify lRequir'oniVnts) --------- --------0--------/-L -a-c-4-4-------4111«S-------------:Z=-------- K 10 <br /> -------------- <br /> -------- ------------------------------------------- -------- ---------S-`--------------------------f- -------- <br /> ;------------------------------------------------------- <br /> ------------- ------- --- ---------- -------- <br /> ------------------------------------------------------ ------------------------ -------------------- ------- -------------------- <br /> -(Draw existing and required addition on reverse side) <br /> ' <br /> I hereby certify that I have prepared this application and that the work will be clonei in- ccig;dance with San Joaquin <br /> County Ordinances, State Laws;and Rules and Regulations of-the Son Joaquin L'O'Cal4le"alf9rDistrild. Home owner or licen- <br /> sed agents signature certifies the'follo'wing <br /> "I certify that in the performance of.'4he'wo'r'k,f'or which-this permit-is-issued,-1-'shall-not-employ any pe: rson.in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed <br /> ------------------------ -- Owner . <br /> By - --------------------- <br /> Title ---------- ---------------------- ------------------------------------ <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----- -- ---------- -------------- ------- 'DATE 1-77172 <br /> ----------- . ................. ------------------------------- <br /> r __ _-_0-------- ---- ------------- <br /> BUILDING� PERMIT ISSUED ------- --------- - - f� �,_ -- -----------------------------------DATE <br /> ADDITIONAL COMMENTS ------:1 . ....L-� ,____ <br /> - -------- ----------------------------------------------:---------------- ------------ ---------------------- --------- -------------- --------- <br /> ----------------------------- --------------------- ---------------------�------------------------ ---------------------- ---------------- ---------- <br /> ------------ <br /> "..;----------------- ---------------------------------------------- <br /> - -------------- --- - ---- <br /> ------------------- ----------------------------------- -------------------------------- ------- <br /> ------------------ ----------------- - i " <br /> Inspection by. <br /> Fina ---------------------- <br /> F-----------:7 ---------- <br /> l' at-e-_ V <br /> ------ ----- - ------------------------------------I---------------------------------- 'Date- <br /> SAN JOAQUIN' LOCAL HEALTH DISTRICT <br /> T <br /> 1268 Rev. 5M, c, <br /> E. H. 9 <br />
The URL can be used to link to this page
Your browser does not support the video tag.
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).