87-1347 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR PERMIT SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. HAZELTON AVE., STOCKTON, CA Telephone (209) 466-6781 �1& 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. trade 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. STOCKTON if Job Address '1 02 RHODE- ISLAND city Lot size PM Owner's Name ROBERT NOWLIN Address 9 502 RHODE ISLAND ` Phone 465-2436 � Contractor VETTER PLBG. CQ .Address 1 035 S. AURORA ST. License No. 202228 Phone46_ 3- 1 06 TYPE OF WELL-/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ 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 f-CONSTRUCTION SPECIFICATIONS ri Dia. -ExcavationM---- -••—_Dia:,of-Well-Casing El Industrial Ll Bottom _ �.Mantecav�.,Dia-�of,W ❑ Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications ❑ Public l] Other ❑ Delta Depih of Grout Seal I Type of Grout Q Irrigation ---Approx. Depth ❑ Eastern Surface Seal Installed.by. t ,C Repair Work Done ❑ Type of Pump H.P. State'Work Done E Well Destruction ❑ Well Diameter I Sealing Material (top 501 r, Depth _ -Fillei Material (Below 50 f'-- TYPE '-TYPE OF SEPTIC WORK: NEW INSTALLATION F1','REPAIR/ADDITION ❑r DESTRUCTION ❑I INo septic system permitted if public sewer is available within 200 feet.) Installation will serve: Residence— Commercial_ Other V Number of living units: Number of bedrooms 4' Character of soil to a depth of 3 feet: h1�r�,�ti Water table depth SEPTIC TANK Type/Mfg Capacity No. Compartments ,'PKG. TREATMENT PLT. Elr Method of Disposal ' Distance to nearest: Well Foundation Property Line I LEACHING LINE ❑ No. & Length of lines ## Total length/size I d FILTER BED ❑ Distance to nearest: -Well--- -- —'Fovndation '" --Property'Line I SEEPAGE PITS ❑ Depth Size Number SUMPS ❑ Distance to nearest: Well Foundation Property Line DISPOSAL PONDS Q 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 Local Health District. 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."Contractors 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 1 The applica ust call for all re u1 nspections. Complete drawing on reverse side. Signed XTitle: PRESIDENT Date: 4/1/87 � FOR DEPARTMENT USE ONLY Application Accepted by Date — Area Pit or Grout Inspection by Data Final Inspection by Additional Comments: Q'- ❑ Stk 466-6781 ❑ Lodi 69-3621 ❑ M teca 823-7104 ❑ Tracy 835-6385 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 CSR RECEIVED BY DATE PERMIT NO. INFO + EH 13-24(REV.1/85) EH 14-26 ;�Tv