91-0034 - Laserfiche WebLink

Metadata

Thumbnails

Annotations

APPLICATION FOR PERMIT h � SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION P 0 BOX 2009, STOCKTON, CA 95201 (209) 468-3447 ICA .TOB 18 f, G-4&,:.G R 20-3441=01 531f W-a� (Complete In Triplicate) Application Is hereby trade to San Joaquin County for a permit to construct and/or install the work herein described. This application In made in compliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San Joaquin County Public Health Services. APN 159-11-16, 14, & 15 MEADOWOOD SUBDIVISION Job Address NW Corner Cardinal Ave & Main St. , City Stockton Lot Size/Acreage Stockton,CA 95207 Owner's Name Becker & Hamilton Address 2575 Grand Canal Blvd, Su.100 Phone Spec 2825 E. Myrtle St. License No. 512268 Phone948-1345 Contractor -- - TYPE OF WELL/PUMP. NEW WELL ❑ WELL REPLACEMENT Cl DESTRUCTIONS eut%1fL-0ekftce'i1'e*r–El PUMP INSTALLATION O SYSTEM REPAIR ❑ OTHER Cff 5ft�eeet� � �C7 DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. Pflot–tlfdE 55-6 Test Bor Lngs FOUNDATION AGRICULTURE WELL OTHER WELL SUMPS LQL-15' Dee INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS Dia. No GW * Industrial ❑ Open Bottom ❑ Manteca ' Dia. of Well Excavation Anticipated U Domestic/Private ❑ Gravel Pack ❑ Tracy _ Type of Casing Spec*cations If GW ®",. [7 Public C1 Other ❑ Delta Depth of Grout Seal TVpr'df-Grote Encountered CJ Irngauan �,Approx, geplh ❑ Eastern Surface Saul Installed by will backfill with Repair Work Done ❑ Type of Pump H.P. State Work Done _ "Hole Plug" Welt Destruction ❑ Well Diameter Sealing Material i Depth ^_ Depth Filler Material A Depth TYPE OF SEPTIC WORK: NEW INSTALLATION❑ REPAIR/ADDITION Ll DESTRUCTION CI (No septic system permitted if public sewer is available within 200 feet.) Installation will server Residence— Commercial_ Other Number of living units: Number of bedrooms Character of soil to a depth of 3 feet: Water table depth SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT, ❑ Method of Disposal Distance to nearest: Well Foundation. Property Line LEACHING LINE ❑ No. A Length of lines Total length/site FILTER BED ❑ Distance to nearest: Well Foundation Property Line - f SEEPAGE PITS I 1 Depth Size Number SUMPS Ll Distance to nearest: Well Foundation Property Line , DISPOSAL PONDS ❑ I hereby cenify that I have prepared this apphcation and that the work wilt be done in accordance with San Joaquin county ordinances, state laws, and rules and regulations of the San Joaquin County' 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 shalt not . employ any person in such manner as to become subject to workman's compensation laws of California." Contractor's 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 taws of California," The applicant st call for required inspections. Complete drawing on fevers@ side. Signed Xs Title: En_gineering Geologist Date: 1-3-91 F R D PARTMENT USE ONLY Application Accepted by Dat / Area Pit or Grout Inspection by Da a Final Inspection by- Jam` Date t 74 Additional Comments: �� d r� / i .. 11'3, Sr J 7 y – Applicant - Return all copies to: SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION PERMIT/SERVICES 445 N SAN JOAQUIN, P O BOX 2009, STOCKTON, CA 95201 �` r INFO EEE AMOUNT DUE AMOUNT REMITTED CASH RECEIVED BY DATE PERMIT'NO. EH 13.24 IREV.1in5i n[� f loll JH 14-264