89-2993 - Laserfiche WebLink

Home Browse Search

, /o �v APPLICATION FOR PERMIT SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. HAZEL T ON AVE., STOCKTON, CA Telephone 12091 466-6781 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (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 17550 W . B Y R O N RD . City TRACY Lot Size PM Owner's Name Address ACYPhone 835-0195 Contractor HENNINGS EROS. DRILL Address 3525 RELANDALE AYE, License No. 290813 Phone 545-1185 TYPE OF,WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION IN 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 ❑ Manteca Dia. of Well Excavation Dia. of Well Casing ❑ Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications 1-1 Public ❑ other ❑ Delta Depth of Grout Seal Type of Grout---- I rout __I I Irrigation _.Approx. Depth t I Eastern Surface Seal Installed by - Repair Work Done ❑ Type of Pump H.P. State Work Done— Well Destruction U Well Diameter 611 Sealing Material (top 501 RENTONITE Depth ()0 t Filler Material (Below 501 -- r TYPE OF SEPTIC WORK: NEW INSTALLATION l 1 REPAIR IADDITION l I DESTRUCTION I ) (No septic system permitted if public sewer is available within 200 feet-) Installation will serve: Residence_ Commercial_— Other Number of living units: Number of bedrooms Q Character of soil to a depth of 3 feet: Water table depth SEPTIC TANK ❑ Type/Mfg Capacity No, Compartments PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Well f Foundation Property Line LEACHING LINE ❑ No. & Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Line SEEPAGE PITS I I Depth Size Number SUMPS L1 Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ hereby certify that l 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 Diltrict. 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 followirig:,"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 applicant must call for all required inspections. Complete drawing on verse side. Signed X HENNINGS BROS . Y Title: Date: 12-6-89 FOR QEPARTME T USE ONLY Application Accepted by Date Pit or Grout Inspection by Date Finale inspection by�� f_ ! ,- ate Additional Comments: qtr ❑ Stk 466-6781 ❑ Lodi 369.3621 ❑ Manteca 823-7104 ❑ Tracy 835 ' Applicant- Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 FEE AMOUNT DUE AMOUNT REMITTED CK RECEIVED BY DATE PERMIT'NO. INFO ��--^^ �7CAA/SH ] / �c� ' +.EH 13-241SEV.i/Hsi ��. l7Z� 3J- 0-0 ot_(V'� / [.y}i� �a-'�7 `-' / g{_a 3 EH 14-26 , r M1 I�l 5 1