92-0670 - Laserfiche WebLink

Home Browse Search

.w 'SAN-JOAQUIN" COUNTY PUBLIC HEALTH SERVICES ,� ENVIRONMENTAL HEALTH DIVISION '` 445 N SAN JOAQUIN, PHONE (209)46$— jj P O BOX 2009, STOCKTON, CA 9520 4 n U PERMIT MIRES 1 YEAR FROM DATE ISSUED r (Complete in Triplicate) 24 1992 Application is hereby made,to San Joaquin County for a permit to construct and/or int e work herein described. This application is made in compliance vith San Joaquin,County Ordinance No. 549 and 1862 �J�JiI�tione of San Joaquin County Public Health Services. PERMITISERVICES Job Address q+Z `,, UmIlryYl kyie- City Lot Size/Acreage (h �I W 12 -p,a Co Addr ss �D� �[ �� i� �, C& I 5 3�� (Z69) 5911 +2 4-R Owner's Name __ ��, IPhone Contractor v Address 1"A(- t+^ -icense No, S.3i447Phone 24A" 703 TYPE OF WELL/PUMP: NEW WELL WELL REPLACEMENT n DESTRUCTION CI out of Service well D PUMP INSTALLAwT'IO �J SYSTEM-REPAIR ❑ ' OT ER El _ Monitoring well L]DISTANCE TO NEAREST: SEPTIC TANK L]C SEWER LINES >6 -, _ DISPOSAL FLD. PROP. LINE'2� FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS KIndustrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation ZO Incl.h Dia. of Well Casing _3 El Domestic/Private k1 Gravel Pack C1 Tracy Type of Casing�3t.��-C�� Specifications ILA`iv%6, uut 1'1 Public 1-1 Other F1 Delta Depth of Grout Seal `f e r Type of G rout 115 mit4A'1C•n± f I Irrigation -OVI�Approx. Depth I I Eastern Surface Seal Installed by Repair Work Done. LJ Type of Pump H.P. State Work Done Welt Destruction ❑ Well Diameter Sealing Material d, Depth v Depth- Filler Material A Depth TYPE OF SEPTIC WORK; NEW INSTALLATION I I REPAIR/ADDITION I } DESTRUCTION I I (No septic system permitted if public sewer is } Y available within 200 feet.1 Installation will serve: Residence_ Commercial Other f V Number of living units: Number of bedrooms Character of soil to a depth of 3 feet: Water table depth i SEPTIC TANK ❑ T Ype/Mfg Capacity No. Compartments PKG. TREATMENT PLT.❑ Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE CI No. & Length of lines Total length/size FILTER BED Cl Distance to nearest: WeII Foundation Property Line f � SEEPAGE PITS I I Depth Site 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 applicant must call required inspections. Complete drawing on reverse side. Signed Title: Date: R PARTMENT USE ONLY Application Accepted by Date r� 2- ren Pit Grou napsction b Dat / S Final Inspection'by Date ^ Additional Comments: cC - Applicant, - Return all copies to: San Joaquin County Public Health Services i * Environmental Health Permit/Services 445 N San Joaquin, P 0 Box 2009, .Stkn, CA 95201 f V � INFO AFEEMOUNT OUE AMOUNT REMITTED CK RECEIVED BY DATE PERMIT'N0. « EH 13.24 IREV.t/BSI �� , EH 1 42e Lir 1V, �