83-1228 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR PERMIT i SAN JOAQUiN LOCAL HEALTH DISTRICT 1601 E. HAZELTON AVE., STOCKTON, CA PERMIT NO. '93 - Telephone (209) 466-6781 DATE ISSUED PERMIT EXPIRES 1 YEAR FROM DATE ISSUED !E (Complete in Triplicate) W 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 lis made in compliance with San Joaquin County Ordinance No. 544 for sewage or No. 1862 for well/pump and the Rules and Regulations of the San Joaquin Local Health District. 7�� h Job Address p 40 " divis1on Name Owner's Name � f Address Phone Contractor's Namea ;'"� License No. , Phone ` Owneri s Name �I v Phone 't . .xe nT..� `�T..,. Il� ..f ��f/� ' i•L�Ci„ � i�v - ..r•.-�iv.r�i �.r�U'.`ZCir� Jfn FOUNDATION AGRICULTURE WELL_..---- OTHER WELL��- PITS/SUMPS r INTENDED USE TYPE OF WELL P.ROBLEh.L.AREA .._ ? CONST.RUCION SPECIFICATIONS !] Industrial 01J Open-Bottom 's Mantec -�r Dia. of Well Excavation U Domestic/Private �.-- jj Gravel Pack Q_,Tracy" Dia, of Well Casing Public " p Other - Delta Type of Casing „rLj'Irrigation `.; "�Ap`prox. E] Eastern -- — Depth Specifications ' Cathodic Protec.ti-ofnp -' I Depth of Grout Seal Genphys'ical Type of Grout } N Other' �} Surface Seal Installed by i Repair Work Done D Type of; Pump H.P. State Work Done k Well Desty> tion ❑ Well Diameter Sealing;Material (top 501) 1 Depth IF, Filler Material '(Be)oA50'} I (� TYPE-OFV9PTIC'WORK: -NEIL-ITT5TACLATI`0N-;—REPA•iR/A'DDITION�`'J-"('No-septic•tank:or seepage pit permitted-Jf-publiczsewer�is A �� ”' • available within 200 feet.)' n Installation will serve: Residence -.*,Commercial Other 1 ' Number of living units: - Numberof=bedrooms _ Lot size -��. _ ! �tF Character of soil to aLtlepth Qf 3afeet +, t ,1+ Water table depth SEPTIC TAN Ty'pe/Mfg VAL , Capacity _ /. ,_ No. Compartments I PKG. TREATMENT PLT. Type/Mfg Capacity Method of Disposal r ` SEWAGE SYSTEM Distance to nearest: Well Foundation Property Line ,,1 j DESTRUCTION LEACHING LINE N60, & Len th of lines g `�'��-- �p � Total length/size FILTER BED .; Di'itance to nearest.: Well 3+i Foundation.,<`l1> Property Line F� -- iF - u SEEPAGE PITS -- M Depth - - Size 1`TNumb Irk SUMPS !—i Distance to nearest:-Nie]1 .' Foundations 3 I Property Line DISPOSAL PONDS -�- y 4 I hereby certify that I have prepared thi_s_app1j.p tion and titiat the work will be done in accordance with San Joaquin county o ordinances, state laws, and rules and regulations ofithe San Joaquir oca.l Health District. r� �(*,^y } f" Home owner or licensed agentij's signature certifies the following: ' I cern f1 that` iln the perforrlan�e of.the work for'wliich this permit is issued, I shall not employ a ny)pers5on',iA--such manner„as to, become subject to workmaht-�compensati,on laws,of California.” Contractor's hiring or sub-contrbcting signaturecertifiesthe following: I certify"tTibt in the performance—dr the work for which this permit is issued, I shaijll employ persons subiect to workman's compensation laws of California." The applicant must cal forre red inspections.' Complete drawing on reverse side. I � ay � Signed X. ,( 3 _ � Title: _ p � -- -- - - Date: —�,.[ { I� FOR D P TMENT USE ONLY Application Accepted!'iby "' i Area _ �� {�� StK 466-6781 o Additlional. ommen.ts: �I Y Lodii 36936217 ` Pit or Grout Inspecti`o'n b Date Manteca 823-7104 Final Inspection by �I///' Date ;+��3 L7 Tracy 835-6385 .o- 1 Applicant - Return all copies to: Envir ental Health Permit/Services 1601 E.�Hazel ton Ave., P.O. Box 2409, Stk., CR 95201 FEE BASE AM�UNT wDUE_ AMOUNT REMITTED RECEIVED BV �DAEPERMIT N0. EH'13=24 REV'10./82.a"a` . _ .__---- - ---" -•- Yt.t/ 14-26 1 Y }