91-1217 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR PERMIT SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES LM8TTON ENTAL HEALTH DIVISION �ezz 1z SAN JOAQUIN COUNTY'PU$LI AVE. , PHONE (209)468-- "Y41 OX r ENVIRONMENTAL MAN% 2009 STOCKTON CA 95201 �f X f1 S i SPECIAL PER, EXPIRES I YEAR FROM DATE Is FEI ��TgL��1 (Complete in Triplicate) /0 � Q� Application is hereby made.to San Joaquin County for a permit to construct and/or install the work herein desc4ad Th1s application is made in compliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San Joaquin County Public Health Services. City Job Address 7647 PACIFIC AVENUE Cit STOCKTON Lot size/Acreage 16,500 S /FT Owner's Name THRIFTY OIL CO. Address 10000 LAKEWOOD BLVD DQWNEY CA Phone 213-923-9876 Contractor SB&S ENVIRONMENTAL DXddress 3022 W. SANTA ANA FRES&,nse No, 057560175 Phone_209-227-828 3 TYPE OF WELL/PUMP: NEW WELL C7 WELL REPLACEMENT F3 DESTRUCTION Ll Out of Service Well Cl PUMP INSTALLATION O SYSTEM REPAIR ❑ OTHER O Monitoring Well DISTANCE TO NEAREST: SEPTIC TANK SEWED R LINES <6--o-" DISPOSAL FLD, PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS T INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS n Industrial ❑ Open Bottom 0 Manteca Dia. of Well Excavation 8TTDia. of Well Casing 2" s I') Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing P-yc Specifications Schedule 40 I') Pubtic f$9ther Cl Delta Depth of Grout Seal Ot - 291 Type of Grout Sand/Cement I i Irrigation 55 Approx. Depth l I Eastern Surface Seal Installed by SB&S ENVIRONMENTAL DR1L1,TNa__ Repair Work Done 0 Type of Pump H.P. State Work Done Well Destruction ❑ Well Diameter 211 Sealing Material & Depth Bpntnni to 9Q1 - A] ?_ �{ Depth Filler Material a Depth #3 Sand 31__ — 55__ TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION i I Mo septic system permitted if public sewer is available within 200 feet.) 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. D Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE Cl No. 8 Length of lines Total length/size FILTER BED Cl Distance to nearest: Well Foundation Property Line SEEPAGE PITS l I Depth Sire __ Number SUMPS LI Distance to.nearest: Well 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 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 applica t must cat for alt required inspections. Complete drawing on reverse side. Signed x 1144W44 321 Title: PRINCIPAL SSB ENVIRONMENTAL Date: 17& 13, 1 CONSULTANTS INC. OR DEPARTMENT USE ONLY Application Accepted by Date rea Pit or Grout Inspection by Date Final Inspection by Aft;� � � Additional Comments: el SAN j0A UIN COUNTY., AI ViSIQN ENPIRUIQMRi��rtal.�I =LTH-]]Y_ Applicant - Return all copies to: San Joaquin County Public Health �� PERMIT�I��' Services, Environmental Health Permit/Servic �+�j�f� i 1601 E. Hazelton Ave., P 0 Box 2009, Stockton, A 5 O1 )NFO FEE AMOUNT DUE AMOUNT REMITTED I CASH RECEIVED Y DATE PERMIT'NO. • EH 13-24 IREV.1/r 57 kzep_� G-�,�/�Z�"7 �/—. EH 34-26 .✓✓J !I ! !!!