89-2714 - Laserfiche WebLink

Home Browse Search

+ APPLICATION FOR PERMIT y SAN JOAQUIN LOCAL HEALTH DISTRICT PAYMENT { 1601 E. HAZE T ON AVE., STOCKTON, CA RECEIVED Telephone 1209) 466-6781 PI PERMIT EXPIRES 1 YEAR FROM DATE ISSUED OCT 3 1989 (Complete in Triplicate) ENVIRON Application is hereby made to the San Joaquin Local Health District for a permit to construct and/or install the worktion is 'Wade in compliance with San Joaquin County Ordinance No.549 for sewage or No. 1862 for well/pump and the RulesWiffitIES'aTn"Joaquin Local Health District. p.� .�,.«,.u.... �� b �24-0 f �Job Address Share Arm -- 1C,De Ot ,4441 '� �� City Lathrop---. Lot Size� PM f Owner's Name Department of Army Address _LK-Cap.ito.lMall .—Sacramento Phone (916)649-013-1 Contraciar Beyl i k Drilling InC Address 3429 Longview Drive License No. 3D�29��Phone 2 TYPE OF WELL/PUMP: NEW WELL X WELL REPLACEMENT ❑ DESTRUCTION ❑ �. PUMP INSTALLATION 29 SYSTEM REPAIR [3 OTHER ❑ DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE FOUNDATION 500 r AGRICULTURE WELL n/a OTHER WELL n a PITS/SUMPS �U INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS © Industrial El Open Bottom 1-1 Manteca Dia. of Well Excavation LDia. of Well Casing 811 ❑ Domestic/Private Gravel Pack ❑ Tracy Type of Casing steel Specifications �ry M Public Monitor 171Other ❑ Delta Depth of Grout Seal 50' Type of Grout sand/Cement l I Irrigation T Approx. Depth I I Eastern Surface Seal Installed by Be.(] i k Drl 1 i Ylg. h - `Repair Work Done ❑ Type of Pump H.P. State Work Hone _ Well Destruction ❑ Well Diameter Sealing Material (top 501 y .1. Depth Filler Material {Below 50') + __ TYPE OF SEPTIC WORK: NEW INSTALLATION 11 REPAIR/ADDITION ! I DESTRUCTION I I (No septid•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 ❑ Type/Mfg Capacity No. Compartments ri + PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Well Foundation Property Line �I EACHING LINE ❑ No. & Length of lines Total length/size I Il4 FILTER BED Ll Distance to_nearest: Well Foundation Property Line I�� SEEPAGE PITS I I Depth Size _ Number �. SUMPS CI Distance to nearest: Well Foundation Property Line r DISPOSAL PONDS ❑ i 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. I Home owner or licensed agent's signature certifies the following: "I certify that in the performance of the work for which this permii,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- lion laws of California." ;i- The l- The applicant must call for all required inspections. Complete drawing on reverse side. �+ Signed x Title: Project Managercote: 9-27-89 David S. Bardsley R D MENT USE ONLY €Application Accepted by Date r 1 Pit or Grout Inspection b Date � 6 Final Inspection �– Date .�J. Additional Comments: �. O Silk 466-6761 ❑ Lodi 369-3621 ❑ Manteca 823-7104 ❑ Tracy 835-6385 t ' Applicant - Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.D. Box 2009, Stk., CA 95201 CK P INFO FEE AMOUNT DUE AMOUNT REMITTED SH RECEIVED BY DATE PERMIT'NO. +.EH14.-28IREV.iin5l 3l_o� ' EH 11-28 s C� �Io 9 1 �S9'-s-'I, R kk