90-631 - Laserfiche WebLink

Home Browse Search

I I APPLIG�►TION' FOR PERMIT J SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. WAZE'kiON AVE., STOCKTON, CA f Telephone (209) 466-6781 PERMIT EXPIRES I 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. 11 j ` I ! Job Address 19215 Oakwood City Stockton Lot Size PM f � Owner's Name Tim DIpgan Address II 19215 Oakwood Phone 464-8170 " Contractor dart _n r m 5 Reed Road 360-851 y Inc License No. Phone 847-0394 t TYPE OF WELL/PUMP: NEW WELDWELL REPLACEMENT ❑ DESTRUCTION ❑ PUMP INSTALLATION LJ SYSTEM REPAIR LJOTHER ❑ _.,.DISTANCE TO NEAREST: SEPTIC TANK_ K O 'SEWERyLINES r: P DISPOSAL FLDCS14 PROP. LINE FOUNDATION AGRICULTURE WELL 133A7e OTHER WELL��PITS/SUMPS 1L Al INTENDED USE S TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ Industrial f 7p,OpenBottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing 6 t ❑ Domestic/Private I l l Grave! Pack ❑ TracyI Type of Casing steel $t Specifications b e n t O n i t ` 1`1Public ❑Other ❑ Delta I Depth of Grout Seal 50 Type of Grout__. __ i I I Irrigation ��_..Approx. Depth I 1 Eastern 5Surface Seal Installed by _ Repair Work Done 43 Type of Pump Subm H,P. State Work Done Well Destruction ❑ Well Diameter Sealing Material (top 50') Depth Filler Material (Below 50') �1 I TYPE OF SEPTIC WORK:. NEW INSTALLATION f 1 REPAIRY N.DDITION l ) DESTRUCTION l I INo septic system permitted if public sewer is !� available within 200 feet.) Installation will serve!—Res Bence_ Commercial_ Oth'er Number of living units: 9T Number of bedrooms Character of soil to a depth of 3 feet:- I Water table depth i SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Well I Foundation Property Line I� U 1 LEACHING LINE L1 No. & Length of lines IN Total length/size U f` FILTER BED ❑ Distance to nearest: Well Foundation Property Line j IN SEEPAGE PITS i I Depth Size II Number t SUMPS LlI Distance to nearest: Well IM Foundation Property Line L j DISPOSAL PONDS ❑:I I hereby certify that I have p,tepared 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. j 6 Home owner or licensed age'nt's signature certifies the following: ,41 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 taws 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:pplica m t call for a1E required inspectio s. ompleta Bra ing a averse side. Signd X + ills: '/ 1 + Date:0 0 ly FO DEPARTIIRENT USE ONLY Application Accepted by Ij h Date — Area u Pit or Grout Inspection'by ��+ � Date J Final Inspection by �` J Date 3 �a Additional Comments: ❑ Stk 466-6781 ❑ Lodi 369-3621 ❑ Manteca 823-7104 ❑❑/Tracy 5 G Applicant- Return all copie 11 to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk. CA 95201 1 � FEE i AMOUNT DUE AMOUNT REMITTED K RECEIVED BY DATE PERMIT NO. INFO J SH + EEH 3-24 H 13-26(REV.II"5! I [ 1 /\y'r — . � —\ ��1�� 0 A 03 I�