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74-612
EnvironmentalHealth
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WHISKEY SLOUGH
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4479
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4200/4300 - Liquid Waste/Water Well Permits
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74-612
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Entry Properties
Last modified
4/18/2019 10:04:10 PM
Creation date
12/1/2017 1:06:59 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
74-612
STREET_NUMBER
4479
Direction
S
STREET_NAME
WHISKEY SLOUGH
STREET_TYPE
RD
City
HOLT
APN
13110002
SITE_LOCATION
4479 S WHISKEY SLOUGH RD
RECEIVED_DATE
05/30/1974
P_LOCATION
NOMELLINI
Supplemental fields
FilePath
\MIGRATIONS\W\WHISKEY SLOUGH\4479\74-612.PDF
QuestysFileName
74-612
QuestysRecordID
1984331
QuestysRecordType
12
Tags
EHD - Public
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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No.� / <br /> (Complete In Triplicate) <br />? <br /> ........... Date.....__ <br /> Date Issued .,7_«.n -/ <br /> This Permit Expires 1 Year From Date Issued <br /> X31 <br /> /00-02-- <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 /> L✓,Gt�1.......CENSUS TRACT <br /> JOB ADDRESS/LOCATION . ....:., qtr ,•- •• ...Phone ....... <br /> Owner's Name ._ /u.. .�, f�� ...................................... <br /> .. ................ <br /> Address ................................•.... City ,y <br /> License #r�.flJ'�� '��--- Phone � � �'...'� <br /> y� .... <br /> Contractor's Name .. fir .` ,���/. r---._----•-- .�x..... <br /> Installation will serve: Residence [3Apartment House❑ CommerciglJTrailer Court ] <br /> Motel ❑Other ............................................. <br /> Number of living units_.-- Number of bedrooms __- ...Garbage Grinder /.x!.17... Lot Size ......---- ........ <br /> Y . Peat : Sandy Loam .. • . ......Private ❑ <br /> Water Supply: Public System and name . . ... . . .... . ..............•--.•---•-------------..--.----.._._..----....----..-_. <br /> Character of soil to a depth of 3 feet. Sand❑ Silt❑ Clay ❑ y IN Clay Loam ❑ <br /> Hardpan ❑ Adobe ❑ Fill Material ......... If yes,type --------------------- ------ <br /> IPlot 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 /> f <br /> Capacity .... Type <br /> : .-- -••---------------.. Material_................... No. Compartments ...................� - <br /> Distance to nearest: Well ---.................................Foundation ...................... Prop. Line .......•.......a.. <br /> LEACHING LINE [ ] No: of Lines ........................ Length of each line.._.._..____-. -.-:...•--_-- Total Length I � � <br /> •-- p ----....... •- <br /> 'D' Box ..__.....:__ Type Filter Material ................ Depth Filter Material -.---..- -----•--- 'n <br /> Distance to nearest: Well ..... Foundation ....... Property Line ..................... <br /> SEEPAGE PIT [ ) Depth .___......_:. _...__ Diameter ................ Number ..._.--___-....-•----....... Rock Filled Yes ❑ No ❑ `1 <br /> Water Table Depth ---------------------------------Rock Size ................................. C <br /> Distance to nearest: Well ........................................Foundation .................... Prop. Line ............__.._..— <br /> a <br /> REPAIR/ADDITION(Prev. Sanitation Permit 5 ............................................ Date ---------___.................. <br /> ) <br /> Septic Tank (Specify Requirements) ----- ------ � � <br /> . ----...._._-�.............•....-- .._ _.... <br /> Disposal Field (Specify Requirements) -•�� � -- - �, _�'".._. �..............e���� ---- <br /> ' f�...� /..klw----------- ------------------ ..------.........-- <br /> ................ ...................................-------------...-••-------------•••............ --------.......................................... ...........................I.................... <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 <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 ----------44 <br /> ... .................................•---....... Owner <br /> By ..... ............. •----• --•----------• <br /> - .----• Titlei r.................._..... ...........: <br /> i other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .... ............................... ........................................ DATE .............,............ ......... <br /> .. <br /> BUILDING PERMIT ISSUED ..............................................DATE ........................................... <br /> ADDITIONAL COMMENTS .....................................:........._...._....._-_-... <br /> ..-•----..__......-•-•.............I..... -----••-----........----.........---••------................----- .---•-.._.......-------•--.........-••---..........._.................•................. <br /> ............. ............................................................ <br /> ...........................................:�... ....Date . .� ................. <br /> •--- <br /> - Final Inspection by: "--"-"""""""' <br /> ---• SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> F 14 1-3 24 j.'b8 Rev. 5M 7/72 3 M <br />
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