87-3572 - Laserfiche WebLink

Home Browse Search

APPLICATION'FOR PERMIT ` SAN JOAQUIN LOCAL HEALTH DISTRICT �.. 1601 E. HAZELTON AVE., STOCKTON, CA Telephone (209) 466-6781 - PERMIT EXPIRES 1 YEAR FROM DATE ISSUED I (Complete in Triplicate) f 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. 1662 for well/pump and the Rules and Regulations of the San Joaquin Local Health District. f ' f Job Address 5550 E. Cherokee Road City 1 Lot Size Gary & Leanne Owner's Name Address 5463 Cherokee Rd. Phone -911-3574 Stockton, Calif. 95205 Contractor G. Scannavino Address 5463 Cherokee Rd License No. Owner Phone 9313574 f TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ h PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ DISTANCE EA REST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE -•- +rte - OUNDATION. AGRICULTURE-WELL -,.PITS/SUMPS - --- INTENDED USE TYPE OF W A CONSTRUCTION SPECIFICATIONS ❑ Industrial ❑ Open Bo ❑ Manteca Dia. of Well Excavation Dia. of Well Casing ❑ Domestic/Private ravel Pack ❑ Tracy Type Specifications F] Pubiic f 1 Other ❑ Delta Depth of Grout Seal Type of Grout _ i I Irfi ion _.,Approx. Depth I 1 Eastern Surface Seal Installed by Repair Work Done ❑ Type of Pump H.P. State Work Done_ Well Destruction ❑ Well Diameter Sealing Material (top 50') I Depth Filler Material (Below 50') TYPE OF SEPTIC WORK: NEW INSTALLATION I l REPAIR/ADDITION 1 1 DESTRUCTION bdXNo septic system permitted it public sewer is available within 200 feet.) Installation will senW Residence'"_ Corrtmefcial~_ other Ta ke 't Ill t S ept f C'�Sy S 1;EII! Number of living units: Number of bedrooms Character of soil to a depth of 3 feet: Water table depth 86 ft.. A SEPTIC TANK IX Type/Mfg Capacity_._150 { ,� No. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal t f,ti Distance to nearest: Wellfl0 Foundation Property Line.. -3C Q� —�LEA•CHING LINE ❑ No. & Length of lines Total length/size y FILTER BED ❑ Distance to nearest: Well�Q(�.t Foundation t _.. - Property Line 0 0 1 SEEPAGE PITS I I Depth Size Number _r SUMPS Cl Distance to nearest Well Foundation -.- .. Property Line DiSP05—AL PONDS ❑ _ a"' -�:-"�`:,4,.-�;;� �.�---- -• --� �.: _.�..� _..�-. �..�� ...._ 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 i rules and regulations of the San Joaquin Local Health District. r. 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 asto become subject to workman's compensation laws of California."Contractor's hiring or sub-contracting signature ' certifies the following: "I certify that in';A e,performance of the work for which this permit is issued;I shall employ persons subject to workman's compensa- tion laws of California." i The applicant must call for all required inspections�`..Gomplete drawing on reverse side.i Signed X Owner Date: 9-17_87 FOR DEPARTMENT USE ONLY y� Application Accepted by Date C�2 '' P Area �1 i Pit or Grout Inspection by Date Final Inspection by Date � �] Addis bnal Comments: c / )(Stk 466-6781 ❑ Lodi 369-3621 EJManteca 823-7104 E1 Tracy '835-6385 plicant- Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 } INFO _AMOUNT DUE-. —•�-AMOUNTAEMITTEO Gk EGEIVED-l3Y-, . ... 451 ' y. DAT E,.,r,,,:,,._—PERMIT*NO.-.. c + EN 13-24 IREV. i x sl EH 14.26, ! j