91-0210 - Laserfiche WebLink

Home Browse Search

W f ,SITE Ss ,;6LD R \TR CROSSING APPLICATION FOR PERMIT ; 6J h ' r SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES rl ENVIRONMENTAL aEALTH DIVISION 7 P O BOX 2009, STOCgTBN-, -CA 95201 (209) 468-3447 .1 , PERMIT.EXPIRES I YEAR FROM DATE ISSUED '} �QO� �f �Jo�aqn (Complete in Triplicate) Application is hereby made,to Snty for a permit to construct and/or install the work herein described. This i application Is made in coupliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San Joaquin County Public Health Services. Doc. No. 84026835 Job Address South Side I-Iwy.l 4 @ Old River City Lot Slxe/Acreage N/A { 1 93230 Owner's NameGra1Von Nichols Address 13762 First Ave:; Hanford CA Phan 209)465-5600 I P.O. Box 50367 Contractor Pitcher Drilling COAddress Palo Alto CA 94303 License No. 263085 Phone(415) 328-891 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ Out of Service Well Cl PUMP INSTALLATION 0 SYSTEM REPAIR M OTHER O Monitoring well ; DISTANCE TO NEAREST: SEPTIC TANK 750' SEWER LINES X50 DISPOSAL FLO. 50 r PROP. UNE 150' e FOUNDATION 30 r AGRICULTURE WELL _LLOIL OTHER WELL 50' PITSISUMPS _?_50 INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS JKI industrial ❑ Open Bottom © Manteca Dia. of Well Excavation 5" Dia. of Well Casing 2 U Domestic/Private O Gravel Pack ❑ Tracy Type of Casing PVC Specifications 40 M Public )t Other X Delta Depth of Grout Seat 35Z- minimum Type of Grout Bentonite & CI Irrigation 91L Approx. Depth 0 Eastern Surface Seal Installed by Trennnie Grout Cement i Repair Work Done U Type of Pump H,P. State Work Done - Well Destruction 0 Well Diameter Staling Material i Depth Depth f Filler Material 4 Depth TYPE OF SEPTIC WORK: NEW INSTALLATION 0 REPAIR/ADDITION M DESTRUCTION Ci INo septic system permitted it public sewer is available within 200 feel.) Installation will serve: I Residence J Commercial_ Other Number of living units: Number of bedrooms Q a Character of soil to a depth of 3 feet Water table depth SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ 1 Method of Disposal Distance to nearest: Well Foundation Property Line 1 LEACHING LINE ❑ No. 8 Length of lines Total length/sire 4 FILTER BED n Distance to nearest: Well Foundation Property Line SEEPAGE PITS 11 Depth f Size Number r � SUMPS Li Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ I hereby canify 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 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 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- a tion laws of California." { a The applica c all requ d inspections, Complete drawing on reverse side. Signed Title: �`►'t5 .� FO DEPARTMENT USE ONLY / Application Accepted by / �' Date ^�. rAr�ea Pit or rout spection by `' V Date �- Final Inspection by Date a �� Additional Comments: ` Applicant - Return all copies to: ,BAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION PERMIT/SERVICES 448 N SAN JOAQUIN, P 0 BOX 2009, STOCKTON, CA 85201 FEE INFO AMOUNT DUE ' AMOUNT REMITTED CASH RECEIVED By DATE PERMIT NO. . e i d—S— 1111-0244EH1�•I� nEV.�insi ErL / 7 e N