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73-808
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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73-808
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Entry Properties
Last modified
4/6/2019 10:06:08 PM
Creation date
12/3/2017 5:28:37 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
73-808
STREET_NUMBER
20008
Direction
S
STREET_NAME
NAGLEE
City
TRACY
SITE_LOCATION
20008 S NAGLEE
RECEIVED_DATE
9/11/73
P_LOCATION
PHILIP MARTIN
Supplemental fields
FilePath
\MIGRATIONS\N\NAGLEE\20008\73-808.PDF
QuestysFileName
73-808
QuestysRecordID
1866684
QuestysRecordType
12
Tags
EHD - Public
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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br />.................... o..................... , Permit N7.��..- FV <br /> } <br /> " (Complete in Triplicate) <br /> This Permit Expires i Year From Date Issued bate Issued _.�:rl:..�� <br /> Application is hereby made to the Son 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 /> JOB <br /> egulations:JOB ADDRESS/LOCATION .. ............... ......... <br /> .�... ............... <br /> "lam ...... . .. .......CEN5U5 TRACT .................... <br /> Owner's n <br /> ... . .... ........_.. -••--------------------- --•----•---•-----......_._.._.................._......._..Phone .&���5�.......... <br /> Address ----...__. ...... CityContracto .. .............................................. ----_------------------.License # _--------------- ..... Phone .............................. <br /> Installation will serve: Residence gApartment House❑ Commercial [3Trailer Court 0 <br /> 1 Motel E]Other ........................ •-------------_-- <br /> Number of living units:...-1,..___. Number of bedrooms 3.......Garbage Grinder ............ Lot Size ...... 5. »............... <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 <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 .......................... p f <br /> Capacity Type .... . Material_. No. Compartments .sa�._...�...___.. U <br /> Distance to nearest. Well ------ .�............. <br /> Foundation __ . �._...__.__-. Prop. Line ...� �?..........- 0 <br /> LEACHING LINT: j } No. of Lines"` .--. .....�� Length �f each�line.-----Ro--------------- Total Length ...�9_d I-........... � <br /> •D' Box ....._._---- Type Filter Material --- `�'� Depth Filter Material ---._ AC1............................... <br /> Distance to nearest: Well ------•--__---- Foundation _..VP................ Praperty,Line ............ � <br /> SEEPAGE PIT [ j Depth Diameter ............... Number ............................ Rock Filled Yes ❑ No i❑ <br /> i <br /> Water Table Depth - Rack Size <br /> Distance to nearest: Well .....................Foundation .................... Prop. <br /> ro Line ................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .................................. <br /> ._ r <br /> Septic Tank (Specify Requirements} _ <br /> :....- - <br /> Disposal Field (Specify Requirements) <br /> --------------- <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 <br /> County Ordinances, State Laws, and Rules and Regulations of the Son 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 bec subject to Workman's Compensation laws of CaliforniaaW e� _ ----- <br /> Signed &n �Zerl <br /> ------ - <br /> J;. <br /> By ----- -- ------------------------- Title ....--4(ifer t <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----- /!:......... <br /> ......• -•--._.....-- -------...'___............. DATE ...q"�0_'`�'�--....._.._...__ <br /> BUILDING PERMIT ISSUED --•-a......... ...I-------- ------ -- •--......-...........................••---.....DATE .................................... <br /> ADDITIONALCOMMENTS .......... ................................. ... --------•-------------------•------------............._...................---............................ <br /> •- - - -.. ..._..__... _... .._ <br /> Final Inspectio ... .................................................Date __ -/.:X '. ----... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H.13 2k 1-'68 Rev. 5M r__ 7/72 3 M <br />
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