83-270 - Laserfiche WebLink

Home Browse Search

n PERMIT NO. (1L �S r Teieprone (210°1 46 fs j( -) DATE ISSUED «---� PERMIT EY,P`RES T YEAR FROM. ;AE ISSJED ;Complete it -riplice e) 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 witn San Joaquin County Ordinance No. 549 for sewage or No. 1862 for well/pump �l and the Rules and R gulations of the San 'oaauin Local Health District. t Job Address—7-0b b a SA Ar0f,09f Subdivision Name Owner's Name VAGAL RdLL WS Address711fiN E O WFL Phone 977 --1177 J Contractor's Name U W6LLZ Q License No. 37 f&0 - Phone (o'Z,- 7{ TYPE OF WELL/PUMP WORK; NEW WELL WELL P.EPLACEYENT n DESTRUCTION U PUMP INSTALLATION SYSTZ.�-4PAIR OTHER ~_ DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER 'n ELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA SONSTRUCTI�rJ SPECIFICATIONS L] Industrial U Open Bottom Manteca Dia. of Well Excavation U Domestic/Private Gravel Pack ; Tracy Dia. of Well Casing Public Other LJ Delta Irrigation Approx. Eastern Type of Casing �jCathodic: Protection Depth Specifications Geophysical Depth of Grout Seal Other Type of Grout U � Surface Seal Installed by Repair Work Done Type of Pump - - H.P. A, State Work Done P-16LL_I Well Destruction Well Diameter Sealing Material (top 50') Depth Filler Material (Below 50') ^ TYPE OE SEPTIC WORK: NEW INSTALLATION L-I REPAIR/ADDITION 1 J (No septic tank or seepage pit permitted if public sewer is Installation will serve: Residence _ Commercial Other available within 200 feet.) Number of living units: Number of bedrooms Let size Character of soil to a depth of 3 feet: Water table depth SEPTIC TANK LJ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. U Type/Mfg Capacity Method of Disposal . SEWAGE SYSTEM Distance to nearest: Well Foundation Property Line DESTRUCTION ❑ (p LLACHING LINE J No. & Length of lines Total length/size FILTER BED U Distance to nearest: Well 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 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 compensation laws of California." Contractor' hiring pr su ontracti Signa re certifies the foliowinq: "I certify that in the performance of the work for which this permi s issued, I h Il em To erson subject to workman's compensation laws of California." The applica ust call f r 1 e u r ins ctions. Complete dr ing-on reverse side. Signed X Title; Date: Z L FO DEPARTMENT USE ONLY Application Accepted by �. � � _ _ _ Rrea Stk 466-6781 Additional Comments: Lodi 369-3621 Pit or Grout Inspection by �1.rrnt��Sericps Date Manteca 823-7104 Final Inspection by �0� Date Tracy 835-6385 Applicant - Return all copies to: En i onmehtal Healtv1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 PEE BASE AMOUNT DUE AiMOUNT RENIITTEU RECEI'JED BY DATE PERMiT No. INFO I _ EH 13-24 REV. 10/82 I0182 500 14-26