89-1540 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR PERMIT SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. HAZELT ON AVE., STOCKTON, CA Telephone (209) 466-6781 PERMIT EXPIRES TYEAR FROM DATE ISSUED (Complete in Triplicate} Application is hereby made to the San Joaquin Local Health District for a permit to construct and/or install the work herein described. This application is made in compliance with San Joaquin County Ordinance.No. 549 for sewage or No. 1862 for well/pump and the Rules and Regulations of the San Joaquin Local Health District, Job Address 5740 W. Cali-F=4n Ave. City B n Lot Size PM Owner's Name J.D. Most Const. Address 3941941 X101 1ly_p ge�� y Phone Contractor Hennings Bros __Address 3525 Pelandale M TYPE OF WELL/PUMP: d. License No,2.90813 Phone545_ ` NEW WELL WELL REPLACEMENT ❑ DESTRUCTION ❑ PUMP INSTALLATION ❑1 SYSTEM REPAIR ❑ OTHER ❑ DISTANCE TO NEAREST: SEPTIC TANK 100 SEWER LINES -- DISPOSAL DISPOSAL FLD.100 -!- PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS I INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ Industrial ❑ Open Bottom ❑ Man—face — Dia. of Well Excavation r u Dia. of Well Casing Domestic Private CKGravel Pack rl D Tracy Type of Casing Cl Public ❑ Other CI Delta /Specifications Depth of Grout Seal —$t~n I i Irrigation --Approx. Depth [ I Eastern Repair Work Done 0 Type of Pump Well Destruction Surface Sea! Installed by State Work Done y; 1 Type of Grout N.P. 1"e-1^ -- ❑ Well Diameter Sealing Material (top 50') Depth Filler Material (Below 50') TYPE OF SEPTIC WORK: NEW INSTALLATION I 1 REPAIWADDITION ! I DESTRUCTION E I (No septic system permitted if public sewer is ,r"-sInst_allationn will serve:._ Residence. available within 200 feet.) em-„-- -� Commercial. Other Number of livingunits: } Number of bedrooms 'Character of soil to a depth of 3 feet: SEPTIC TANK ❑ Type/Mfg Water table depth f '� PKG. TREATMENT PLT. 1-1Capacity No. Compartments 0 ' r - Distance to nearest: Well Foundation Method of Disposal Property Line LEACHING UNE ❑ No. & Length of lines r FILTER BEDTotal length/size ❑ Distance to nearest: Well Foundation Property Line SEEPAGE PITS 11 Depth Size !` SUMPSNumber ❑ Distance to nearest: Well Number DISPOSAL PONDS ❑ Property Line I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin county ordinances, state laws, and rules and regulations of the San Joaquin Local Health Di`�trict. + Home owner or licensed agent's signature certifies the following: "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 to become subject tp workman's compensation laws of California.”Contractors hiring or sub-contracting signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall employ persons subject to workman's compensa- tion laws of California." The applicant must call for all required inspections. Complete drawing o r verse si e. SignedX— Hennings Bros. B Title: Date: 6-26-89 R DEPA MENT USE ONLY Application Accepted by �.r Date rp Area Pit or Grout Inspection by Date Final Inspecti Additional Comments: �a�` c�L lam ' ate L7 Stk 466-6781 ❑ Lodi 369-3621anteca 823'7104 Applicant- Return all copies to: EnvironmEJ Tracy 835-6385 ental A--, f r. . alth Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 n.o 11111 ,FEE AMOUNT DUE INFO AMOUNT REMITTED RECEIVED BY Ell, TE PERMIT NO- +-EH 13-21(REV.1 i K 51 EH 10-26 _ � � .