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71-1085
EnvironmentalHealth
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LONE TREE
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4200/4300 - Liquid Waste/Water Well Permits
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71-1085
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Entry Properties
Last modified
2/23/2019 10:46:41 PM
Creation date
12/2/2017 10:27:39 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
71-1085
STREET_NUMBER
28090
Direction
E
STREET_NAME
LONE TREE
STREET_TYPE
RD
City
ESCALON
SITE_LOCATION
28090 E LONE TREE RD
RECEIVED_DATE
11/18/1971
P_LOCATION
MARION VAN VLIET
Supplemental fields
FilePath
\MIGRATIONS\L\LONE TREE\22890\71-1085.PDF
QuestysFileName
71-1085
QuestysRecordID
1827690
QuestysRecordType
12
Tags
EHD - Public
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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br />- -" ._ •--------------- ------ Permit No:. <br />- 1 <br />(Complete in Triplicate) <br />------------------------------ _-------- ---------------- This Permit -Expires 1 Year From Date issued <br />Date Issued --- <br />Application is hereby made to the San Joaquin Local3`I-tealth District for a permit to construct and install the work herein <br />described. This application is made in compliance wiA\1county Ordinance No. 549 and existing Rules and Regulations: <br />r- /to <br />JOB ADDRESS/LOCATION ----- --t------J ------ '740NZ�TR-Z.�-�- ....... CENSUS TRACT---5�`_-T-�------ i <br />Owner's Name -------.._l_ "/ PR_1-!_O&�------ �f_ln r_\[_ Phone <br />f <br />I / ,, -- ------------------ <br />Address-----------Sj-51---------)3R-E-f(f�.� ---------i��D----------. City -------0 L --L ....................... <br />° <br />Contractor's Name ---- ac-NEK---------------------------------------------t_--------License*------- ----------------- Phone ------------------------------ i <br />Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑Trailer ra%W <br />Motel ❑ Other ----- <br />------------ ----- -------------------- <br />Number of living units ---- 1.------ Number of bedrooms .__.Garbage Grinder___- Q"4�" Lot Size _______- � <br />Water Supply: Public System and name= ----------- -------------------------< ---------------------------------------------- ❑ i <br />haracter of"soilrto_a depth of_$ fee. . _ Sand❑..� S' Clay�O_Peat J;d-.Sand), , Loam;❑,�Clay Loam_[ <br />i Hardpan Adobe ❑ Fill Material ---- If yes, type --___. _________ _____ .- <br />jPlot 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 seepa it permitted if public sewer is available within 200 feet,) <br />'J �r <br />PACKAGE TREATMENT [ ] SEPTIC TANK[ '' Size --$4--10—,; :-5 ---------- Liquid Depth __ 7. ............. <br />i Capacity/ �_ --,-- Type PRECOS7Material !. IS • Compartments- �+ <br />••-- <br />li p9i'ance to nearest: Well ___.1���____f______Foundation __l/._____ Prop. Line ____�__._____ O i <br />IF— <br />Len of each line. <br />- ---------LEACHING LIN: of Lines - �Total Len <br />i <br />I <br />�,'b'_Box. /I!Q__._.T_yp=Filter N1dte�iai _]Q_e-_Depth Filter Material -----------------------_--- <br />Distance <br />--------------------- -•-Distance to nearest: Well ---- �f�f�-_�_rf/ _ Foundation ------- /-f�_- Property Line ____ _____......_ <br />___._ Diameter ___;._ Number _.__.- _ _ ____ Rock Filled Yes No <br />SEEPAGE PIT [�� Depth "%�-- " � - -- / - --- - <br />-- <br />3 i r <br />Rock Siz <br />Water Table <br />I j Q <br />h r r _ :.;_. <br />Distance to nearest: Well --- n ----- .------ Foundation - --- Prop.Line <br />------------ <br />REPAIR/ADDITION <br />REPAIR/ADDITION 1 <br />(Prev. Sanitation Permit #-------•------------------------------------ Date --------- •-------------------1 <br />Septic Tank (Specify Requirements) ------------------- ---------------------------------------------------------------- ----••---- .------------ •------------- <br />i ; r <br />Disposal l Field (Specify RequirementsL ^- <br />_ -�_ <br />----------- ___ _-._ r _ <br />f_ <br />----- -------- <br />(Draw existing and required addition on_ reverse side) <br />I herebya rtify that I! have prepared this application and that, the work will be done in accordance with San Joaquin <br />County%4nance's,f State Laws, and Rules and Regulaiions of the San Joaquin Local Health District. Ham -e, owner or licen- <br />sed agentslsi natire certifies the following: _ <br />"I certify�t the performance f the worVMolt <br />r which this permit is issued, I shall not employ any person in _such manner <br />as to be ubj t to Work a 's Compe>iws liornia." <br />Signed s- -------------- Ownerr� <br />By'T` Q ------------------------------------------------------------ - ---- <br />y ------ - --------------=-------------------------- ----- r--- - Title . 1 <br />(If of l7er thaff o `V,T er) <br />FOR DEPARTMENT USE ONLY <br />APPLIGATIQN ACCEPTED BY ------- �- - t------------------------------------------------------------------- DATE --- 7- <br />BUILbiNGrPERMIT-ISSUED -------=--= -------- <br />ADDITIONAL COMMENTS ------- ,_ ------ ----- ------ <br />te r, .-I -- - <br />- - = Date /l---- -------- <br />Final Ins <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />E. H. 9 1-'68 Rev'.' .15M <br />
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