90-2056 - Laserfiche WebLink

Home Browse Search

`4 r APPLICATION FOR PERMIT SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. HAZEL T ON AVE., STOCKTON, CA Telephone 1209) 466-6781 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) a 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 welUpump and the Rules and Regulations of the San Joaquin Local Health District. I Job Address 159 p E. 8 Mile RD city Linden Lot Size PM Owner's Name L Solari Address 1.5988 E , 8 Mi1P_ Rd . Phone 9 — l 7 Gontractor�'urVianCe Drillersq�r F-0-_64 (1.7707 E.Hwr,Ti2Ai4 Ivo, 377923 Phone887— 554 " TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ PUMP INSTALLATION SYSTEM REPAIR ❑ OTHER ❑ DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing 0 Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications F1 Public Cl Other Cl Delta Depth of Grout Seal Type of Grout I I Irrigation Approx. Depth I I Eastern Surface Seal Installed by I Repair Work Done ❑ Type of Pumpturbine H.p. 10 OHP State Work Done PLM old pump,deve ope Well Destruction ❑ Well Diameter Sealing Material (top 50') well & install new pump Depth Filler Material (Below 50') TYPE OF SEPTIC WORK: NEW INSTALLATION I 1 REPAIRlADDITION I I DESTRUCTION I I INo septic system permitted if public sewer is - available within 200 feet.) Installation will serve: 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 ^A LEACHING LINE ❑ No. & Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Line ` ` ! F SEEPAGE PITS I I Depth Size Number SUMPS ❑ Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ 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 District. 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 to workman`s compensation laws of California." Contractor's hiring or sub-contracting signature I certifies the following: "(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 ap icant st call fo all re uired inspections. Complete drawing an r arse side. Signed X Title: �� /piu Date: g0ZMENT 135E Of11LYApplication Accepted by ' 1/"� Date t) Area Pit or Grout Inspection by Data Final Inspection by Date �� l j Additional Comments: iC ❑ Stk 466-6781 ❑ Lodi 369-3621 ❑ Manteca 823-7104 0 Tracy 835-6365 Applicant - Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 FEE (NFD AMOUNT DUE AMOUNT REMITTED GASB RECEIVED BY DATE PERMIT"NO. +.EH13.24 1AEY.r/n 51 �T 1G r� C_/0 " EH 14"2B V LJ k u