92-2784 - 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 PERMIT EUIRES 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 is made in compliance with San Joaquin County Ordinance No. 549 and 2862 and the Rules and Regulations of San Joaquin County Public Health Services. Job Address 14707 Rcdfir_ ASm,. (offsite-AML-1, Bk102 P.93) CityStrkf•rn Lot Size/Acreage-0_O.X sq. ft- Owner's tOwner's Name Urnall QM=tion Address -().Em Phone Contractor W2stex Address License No.9�98 Phond TYPE OF WELL/PUMP: NEW WELL It WELL REPLACEMENT M DESTRUCTION ❑ Out of Service Well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ Monitoring Well 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 L-1 Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation-8 in- Dia. of Well Casing Cl Domestic/Private r Gravel Pack 0 Tracy Type of Casing Specifications Cl Public I.1 Other fl Delta Depth of Grout Seat _50 fi-_ Type of Gro6h= CEMMt I I Irrigation _,_.Approx. Depth I I Eastern Surface Seal Installed by Repair Work Done U Type of Pump -1;),4a---r— H.P, State Work Done Well Destruction ❑ Well Diameter Sealing Material i Depth ace Depth Filler Material i Depth #3 M-rrteay carr TYPE OF SEPTIC WORK: NEW INSTALLATION I 1 REPAIR/ADDITION I I DESTRUCTION I I (No septic system permitted it public sewer is available within 200 tool.) Installation will serve: Residence— Commercial_ Other Number of living units: Number of bedrooms Character of soil to a depth of 3 feet: Water table depth SEPTIC TANK 0 Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT.❑ Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE ❑ No. & Length of fines Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Line SEEPAGE PITS 11 Depth Size Number SUMPS 1.1 Distance to nearest: Welt 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 taws, 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 taws of California." Contractor's hiring or subcontracting signature certifies the fallowing:"1 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 appttcamsta! r all raqui in ct' ns. Complete drawing on reverse side. Title: CWnex Signed X r Date: Jlt� 29r p1997 FOR DEPARTMENT USE ONLYon Z Application Accepted by Date 1,Z___ Area Pit or Grout Inspection by Date 2' Final Inspection by Date Additional Comments: -HpAhL I h ► C rA4(rjs[0 Applicant - Return all copies to: San Joaquin County Public Health Services Environmental Health Permit/Services 445 N San Joaquin, P 0 Box 2009, Stkn, CA 95201 FEE INFO AMOVNNT DUE AMOV�yNIT REMITTED CASH f RECEIVED BY DATE 9PERMiT'NNO- . EH 13-24(REV.I i 5l g 1,ao $f i z� 1 3 [ RA- M • �' Y/• qZ i z z l EH t1.2a wlZ