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78-914
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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78-914
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Entry Properties
Last modified
6/16/2019 10:13:30 PM
Creation date
12/1/2017 1:14:17 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
78-914
STREET_NUMBER
838
STREET_NAME
WHITE
STREET_TYPE
LN
City
STOCKTON
SITE_LOCATION
838 WHITE LN
RECEIVED_DATE
10/17/1978
P_LOCATION
G F GRAVELL
Supplemental fields
FilePath
\MIGRATIONS\W\WHITE\838\78-914.PDF
QuestysFileName
78-914
QuestysRecordID
1985014
QuestysRecordType
12
Tags
EHD - Public
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FOR OFFICE USE: ! FOR OFFICE USE: <br /> • APPLICATION FOR SANITATION PERMIT <br /> --------------------------------..... .... ... <br /> (Complete in Triplicate) Permit No.,-".K-7:.- ..l <br /> ...............�.....----------- ---------- - ----... Date Issued.�0_...-1�: � <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 ex' mg Rules and Regulations: <br /> JOB ADDRESS/LOCATION.... <br /> -....... <br /> - <br /> `� `� r"--..`.L 11 �� _CENSUS TRACT <br /> Owner's Name.... ........ <br /> ._1�- � �. -Phone .-- - ----------- ---- ---- <br /> Address.................----- /--�.�.. .. .... .. j,� � G . . .a'-.h �.. City-----.------------ ...---.....- _Zip------------- -------- <br /> -0 <br /> ----•-- <br /> Contractor's Name_____ �-t -A-, I-- License #r - �.1- -. ._Phone.-Z�........_----- ---------- <br /> Installation will serve; Residence �rtment House ❑ Commercial ❑ Trailer Court ❑ <br /> Motel ❑ Other.... .............. .... <br /> Number of living units: ...... ......Number of bedrooms.-.a—Garbage Grinde ---Lot Size... ................ .... .. <br /> Water Supply: Public System and name---- ......................... -------------------------------------•--------- --------- - --.--.-----•--------Private <br /> Character of soil to a depth of 3 feet: Sand ❑ Sim Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe Dp/Fill Material/b-.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,) 06 <br /> PACKAGE TREATMENT [ ) SEPTIC TANK <br /> [ l Size.-_------ -----------------------------------------------Liquid Depth..------------------------- <br /> Capacity...._ -------------TYPe---------- ...........Material.-------_---------------No. Compartments ------ ...................... <br /> Distance to nearest: Well-------- ..............Foundation........_- _ . - .. Prop. Line-.--..-----------...- <br /> LEACHING LINE [ ] No. of Lines .. ... .....................Length of each lina------------------------------Total Length _. . ----------- -----......------ 1 <br /> 'D' Box............Type Filter Material...- ...Depth Filter Material-------- -------------------------------------------- --------- <br /> Distance to nearest: Well. .......................Foundation----.------------------ Property Line----------------------- <br /> SEEPAGE PIT [ ] Depth....__ _ -_-Diameter....................Number.------------------------------- Rock Filled Yes ❑ No ❑ <br /> Water Table Depth---------------------------------------------------------Rock Size --- - -------- -------------•--------- -- <br /> Distance to nearest: Well-- ----------- --- Foundation----......................Prop. Line_------ .-..... <br /> REPAIR/ADDITION (Prev. Sanitation Permit#................ ...... ........L.....Date-------------------------.-.------------------ <br /> ) <br /> Septic Tank (Specify Requirements)-- --- -- ------- --. --....y!;-o ..�-. ......}L..... <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 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----------------------------- ------1. - - ------------_...................Title........ . . _ ...... .. � .... <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- C .................... ---- ------ . .............DATE .... ---------- <br /> DIVISION OF LAND NUMBER. DATE. -.............. -- ----- ---- <br /> ADDITIONAL COMMENTS.. ... �\C- xt,•�........ ``� � �� --------- ------_------ <br /> ----------------------•------------- ---•- ----------- ---------------------- --------------- ---------------- ------------- <br /> Final Inspection b ...-Date.-_ <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/76 3M <br />
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