93-0288 - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 P O BOX 2009, STOCKTON, CA 95201 l� PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) Application is hereby made to San Joaquin County for a permit to construct and/or install the work herein described. This application 1s made in compliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San Joaquin County Public Health Services. Job Address 5660 ARCHERDALE RD City silLot Size/Acreage Owner's Name JIM FERRARI Address 5690 ARCHERDALE RD Phone 887-3036 Contractor PLRNTUTIM IR'TfrEWRIlW Address 17707 E 1W 261,IZM License No X7792 Phone - TYPE OF WELL/PUMP: NEW WELL)Q WELL REPLACEMENT ❑ DESTRUCTION O Out of Service Well ❑ PUMP INSTALLATION O SYSTEM REPAIR ❑ OTHER O Monitoring Well C7 DISTANCE TO NEAREST: SEPTIC TANK goSEWER LINES DISPOSAL FLD. PROP. LINE FOUNDATION S�— AGRICULTURE WELL-300 L OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS n Industrial Kl Open Bottom ❑ Manteca Dia. of Well Excavation IV a f Dia. of Well Casing 16 01D FI Domestic/Private O Gravel Pack O Tracy Type of Casing_ S1 Specifications .950 I'l Public [, Cl Other n Delta Depth of Grout Seal 2Wt Type of Grout CEO= n k Irrigation 7�J 45t.Approx. Depth ( I Eastern Surface Seal Installed by �J Repair Work Done U Type of Pump H.P. State Work Done _ Well Destruction O Well Diameter Sealing Material 6 Depth Depth Filler Material & Depth TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I INo septic system permitted if public sewer is available within 200 feet.) Installation will serve: Residence e Commercial— Other Number of living units: Number of bedrooms Character of soil to a depth of 3 feet: Water table depth SEPTIC TANK O Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE ❑ No. & Length of lines Total length/size FILTER BED O Distance to nearest: Well Foundation Property Line SEEPAGE PITS 11 Depth Size Number /J SUMPS LI Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ _ 1 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 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- tion laws of California." The plican call for all qui inspections. Complete drawing on rev er a side. Signed \ Title: _ Date: FOR DEPARTMENT USE ONLY I �{ Application Accepted bjby � M�yQ Date 3--1- `_3 Area Pit o Grout nspection n v 1"v`a Data I'7 Final Inspection by If Dat a Additional Comments: t Applicant - Return all copies to: San Joaquin County Public Health Sery ces �UMiq� �jj µ2� 4uCAG Environmental Health Permit/Services 445 N San Joaquin, P 0 Box 2009, Stkn, CA 95201FEE INFO AMOUNT DUE AMOUNT REMITTED CASH RECEIVED 8Y DATE MV PERMIT'N0. ' EH 13-241REV,iie5i Q N `O� �1 �1 • 1 / •`� *�3 3 �. (l EH 14.26 V 1 1 l