84-1307 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR PERMIT N - SAN JOAQLiN LOCAL HEALTH DISTRICT O C T o r 1984 [[JJ 1601 E. HAZELTON AVE., STOCKTON, CA PERMIT NO. Telephone (209) 466-6781 SAN JOAQU}N L®CAtE Issuu PERMIT EXPIRES 1 YEAR FROM DATE ISSUED HEALTH DISTR�CT, (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 25992 N. Elliott Rd. Subdivision Name Owner's Name JOHN TOLEDO DAIRY Address 25992 N. Elliott Rd. Phone Contractor's Name Goehring Pump License No. 309031. Phone 727-5548 TYPE OF WELL/PUMP WORK: NEW WELL WELL REPLACEMENT F� DESTRUCTION E] PUMP INSTALLATION SYSTEM REPAIR OTHER LJ DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE IJ Industrial U Domestic/Private Public y� Irrigation Cathodic Protection 1-1 Geophysical Other Repair Work Done Z) Well Destruction U TY^F nF WF11 Ppnplrm aRFa ((—f Open Bottom Manteca•_. [] Gravel Pack T Tracy CONSTRUCTION SPECIFICATIONS ti Dia. of Well -Excavation Dia. of Well Casing F-iOtherDelta Type of Casing - A1Spr6R- •...:.-M—E`aSterrt De th w tiySpieci•fications P -0epth=of -Grout.-Seal. _ - Type of Pump Wel] Diameter Depth Type of Grout Surface Seal Installed by subs H.P. 5 State Work Done pulled replaced old Sealing Material (top 50:) _ Filler Material (Below 50'1 . TYPE OF SEPTIC WORK: NEW INSTALLATION ❑ REPAIR/ADDITION 0 (No septic' a k or seepage pit permitted. if public sewer is available within 200 feet.) Installation will serve: Residence Commercial Other --- -� �---^� -, Number of living units: _ Number of bedrooms Loi-si-z�,, -J Character of soil to a depth of 3 feet: 4._ __... _- .. Water.table.depth SEPTIC TANK Type/MfgCapacity No, Compartments PKG. TREATMENT PLT. F-1 Type/Mfg Capacity ----I Method of Disposal SEWAGE SYSTEM Distance to nearest: Well Foundation Property Line, DESTRUCTION LEACHING LINE U No. & Length of lines Total length/size FILTER BED Distance to nearest: WeTI Foundation Property Line SEEPAGE PITS ❑ 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 ent's signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I s not employ any person in such manner as to become subject to workmant compensation laws of California." Contractor's hir' sub -contracting signature certifies the following: "I certify that in the performance of the work for which this Permit i 1 shall en►ploy persons subject to workman's compensation laws of California.", The applican 1 f all required inspections. Cbmplete drawing -on -,reverse 'side. - g _. _ _ _ _ Date: 7 0ZO3Zx4— Signed X �-Ti.t].e� :...BIS r...� ._ Y F DEPARTMENT SE ONLY %® Application Accepted by Area _,O/ {� Stk 466-6781 Additional Comments: Lodi 369-3621 Pit or Grout Inspection by Date Manteca 823-7104 Final Inspection by Date ❑ Tracy 835-6385 Applicapt �'-Returh`a11 copies. to; -. Env.ironmentaI ealth Permit/Services 1601 E. Hazel on P.O. Box 2009, Stk., CA 95201 FEE BASE AMOUNT DUE AMOUNT REMITTED RECEIVED BY DATE PERMIT NO. INFO S.-raa Q EH 13-24 REV. 10/82 10/82 500 14-26