91-0428 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR PERMIT ov SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES PAYMENT ENVIRONMENTAL HEALTH DIVISION RECCE YED P O BOX 2009, STOCKMN', CA 95201 FEB (209) 468-3447 - SAN JOAQUIN COUNTY YEAR ,VRQU IC HEALTH SERVICES (Complete in Triplicate) ENVIRONMENTAL HEALTH DIVISION R 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 COW11anoe;vith San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San Joaquin County Public Health services. Job Address 781 Swift ' ton..,, City: -__ _Stock _�;- Lot Size/Acreage Approx.fir Owner's Name Swift Tranzportatfon Address Phone 943-1476 r ' a CA 95691 Contractor WESTEX } Address P.O. Box 1664.- W. Sats,License No. 552198 Phone 916-173-11 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ Out of Service Well ❑ PUMP INSTALLATION p SYSTEM REPAIR ❑ OTHER IMSOiIM96"Mir1 SWe11 DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE ------, �FOUNDATION-` T-�AGRICUL-TURF-WELL--=--- OTHER-WELk - --PITS/•SUMPS;��,�., - INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS CI Industrial ❑ Open Bottom ❑ Manteca Dia, of Well Excavation Dia. of Well Casing U Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing .Specifications L7 Public [1 Other } � ❑ Delta Depth of Grout Seal Type of Grout t 0 ImUalion — Approx. Depth ❑ Eastern Surface Sedl Installed by Repair Work Done U Type of Pump H.P. State Work Done - + Well Destruction 0 Well Diameter Sealing Material i Depth Neat Cemen r Ut 19.Total Depth t Depth tiller Material & Depth TYPE OF SEPTIC WORK; NEW INSTALLATION fl REPAIR/ADDITION M DESTRUCTION G (No septic stem I p Y permitted if public sewer is 1 Installation will serve: Residence Commercial_ Other available within 200 feet.) _ 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 PKG. TREATMENT PLT. ❑ Method of Disposal F Distance to nearest: Well Foundation Property Lina r LEACHING LINE C1 No. & Length of lines Total.length/size FILTER BED t_I Distance to nearest: Well Foundation Property Line ; SEEPAGE PITS It Depth Size Number SUMPS..----- ..__ _LI .�Dist_tance to nearest.:.,.s.well , fi Foundation �.. Property Lina DISPOSAL PONDS ❑ � - - _. - ,r 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, ander rules and regulations of the San Joaquin County i 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 em tlon laws of California." Pto y persons subject to workman's compensa- The applicant must call for all requir inctions. Complete drawing on reverse side, Signed Title. Pro'ect Geolo ist A en f 1-31-91' Date: �R D . INIENT USE ONLY estex ' Application Accepted by -��2"Z- DateAre 11 PIS or Grout Inspection by Date Final lnspection b . Date Additional Comments: Applicant - Return all copies to: f. P SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION PERMIT/SERVICES 445 N SAN JOAQUIN, P O BOX 2009, STOCKTON, CA 95201 y FEE AMOUNT DUE AMOUNT REMITTED INFO � CASH RECEIVED 8Y DATE PERMIT N0. ' . EH 13•24 IteEv.IiKsi 0C)