87-3554 - Laserfiche WebLink

Home Browse Search

Y 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 (Complete in Triplicate) 7-'?o , 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. S- / f. 4� „/1� _ ar//�L W_n n�3 Job Address .5 mile /west of Escalon/Oellota city Linden Lot Size PM 700 ' North of Flood Rd. Owner's Name Foster Farms Address 2857 Geer Rd. , Turlock Phone ContraA,rVb=DCillpsDd"'rgCorp. Address Pe 0. Box 642LindeMicense No. 377923Phone 887-3554 TYPE OF WELL/PUMP: NEW WELL X $ci.t2-vpWELL 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 171 Manteca pia- of Well Excavation Dia. of Well Casing 10�• At Domestic/Private ❑ Gravel Pack ❑ Tracy Type of CasinOga kia well Specifications 16 ga 1'1 Public X Other Cl Delta Depth of Grout Seal of 1401 Type of Grout cement _ I Irrigation (p3_ef.Approx. Depth l I Eastern Surface Seal Installed by Repair Work Done ❑ Type of Pump H.P. State Work Done_ Well Destruction ❑ Well Diameter Sealing Material (top 50') Depth Filler Material (Below 501 TYPE OF SEPTIC WORK: NEW INSTALLATION Cl REPAIR/ADDITION I I DESTRUCTION i I (No septic system permitted if public sewer is available within 200 feet-) Installation will serve, Commercial— Other Number of living units: Number of bedrooms Character of soil to a depth of 3 feet: Water table depth SEPTIC TvANK © Type/Mfg Capacity o. Compartments PKG. TREATMENT PLT. ❑ Metho osal Distance to nearest: Well Foundation Property Line LEACHING LINE ❑ No. & Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Line SEEPAGE PITS I 1 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 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 laws of California." The applica�'' st call for I required inspections. Complete drawing on reverse side. Signed X -�c. _ Title: President Date: 7/24/87 OR DEPARTMENT USE ONLY Application Accepted by Date C V / Area d Pito Grout nspection b _ ate' Final Inspection by Date Additional Comments: �- �'�` '"'' y ".�t � _ _�,� - ❑ Stk 466-6781 ❑ Lodi 369-3621 ❑ Manteca 823-7104 ❑ Tracy 835-6385 i Applicant - Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 FEE CK 4 IN O AMOUN/TT DUE AMOUNT REMITTED CASH RECEIVED BY DATE PERMIT NO. + EH13-24(REV.t/H 5) EH 14-29 lJ