87-936 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR PERMIT SAN ,JOAQUIN.LOCAL HEALTH DISTRICT 1601 E. HAZEL ION AVE., STOCKTON, C Telephone (209) 466-6781 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED ° (Complete in.T'riplica ) application is -... ` T permit to construct andlor install the work herein described.This app Application is hereby made to the San Joaquin Local Health District for p ith.San Joaquin County Ordinance No.549 for sewage or No. 1862 for welllputnp and the Rules and Regulationsofthe San Joaquin made in compliance w O Local Health District` PM city. . City _ STOCKTONLot Size 2012 ORWOOD Job Address 464-6578 201�2OFWOOD Phone R. =ROB�NSON� Address . owner's Name 202228 Phone 46 _1 D6 S A ORS ST License No. Address 0 DESTRUCTION ❑ Contractor WELL REPLACEMENT ❑ NEW WELL ❑ OTHER ❑ TYPE OF WELLIPUMP: SYSTEM REPAIR ❑ PROP. LINE PUMP INSTALLATION ❑ DISPOSAL FLD. SEWER LINES, � OTHER WELL PITSlSUMPS DISTANCE TO NEAREST: SEPTIC TANK AGRICULTURE WELL FOUNDATION �� TYPE OF WELL PROBL�' �JONSARPCTION's'SPECIFkCATIONS Dia.of�Well`Casing' INTENDED USE ❑ Manteca ' Die of Well-Excavation specifications ' ❑Open..Bdttomf- Type of Casing ? ❑ Industrial _,-., ..--� l ❑ Tracy Type of Grout 4 k ❑ Domestic/Private ❑ Gravel Pack 04y ❑ Delta Depth of Grout al ❑ Public ❑ Other R Surface.Seal-Installed by l rox. Depth-,Eastern ,, ,_ --� 0 ❑ Irrigation app i4 � State Work Done I H.P. Repair Work Done ❑ Type of P ump � (. I Sealing Material ltop 501 f f Well Destruction ❑ Well Diameter Depth I I Filler Material (Below 50') I ermitted if public sewer is = available witf+i�2t.1 / TYPE OF SEPTIC WORK: NEW IN ❑ REPAIRIADDITION,❑ DESTRY UCTION lNo system p � 1 I Other Commercial - ��}�' Q•n r ve vim. installation will serve: Residence t r .-»---�^^'" !� Number of living units: Number`f bedrooms�— Water table depth j Character of soil to a depth of 3 feet: _ No. Compartments l Capacity r'.� r SEPTIC TANK ❑ Type/MI 4 ,„_.., Method of Disposal t ! PKG. TREATMENT PLT. ❑ Foundation Property Line Distance to nearer_t: Weil I r - Total length/size LEACHING LINE ❑L No. & Length�of Ii les F I Property Line 1 + Foundation ! FILTER BED ❑ Distance to nearest: Well b� f 1 Size Number SEEPAGE PITS ❑ Depth I• Property Line i Foundation ' SUMPS ❑ . Distance:to nearest:. --.-Well DISPOSAL PONDS ❑ 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin coynty ordinances, state laws, and rules and regulations of the San Joaquin-Local Health_Distwin f California."Contractor s hiring or sub-contracting signature d a ant's signature certifies the following: "1 certify tihat in he favus of of the work for which this permit is issued, 1 shall not Home owner or license 9 to employ any person in such manner as to become subject the workman ork wh ch this permit is issued, I shall employ persons subject to workman's compensa certifies the following:-I certify that in the pe tion laws of California." R The applica must call for all required inspections. Complete drawing on reverse side. Date: 3/25/87 Title: PRESIDENT ! Signed FOR DEPARTMENT USE ONLY r 1 Ar Date ea Application Accepted by LDate Date —� Final Inspection hY Pit or Grout Inspection by Additional Comments: ❑ Lodi # -36'11 ❑ Manteca 823-7104 El Tracy �5 ` 2009, 5tk., CA 95201 ❑ Stk 466-6781 Applicant- Return all copies to:+Environmental Health PermitlServices 1601 E. Hazelton Ave., P.O. Box tRECEIVED BY DATE PERMIT NO. I -AMOUNT-DUE AMOUNT REMITTED = . '• � + EH 13-24 IREV.I EH 14-28