89-1879 - Laserfiche WebLink

Home Browse Search

{ Aer_. PUBLIC HEALTH SERVICES SAN JOAWUIH COUNTY Y M E NT P.O. Box 2009 P A (160k East Hazelton Avenue) R E G E 1 V ED Stockton, California ' 95201 irk PERMIT FRES 1YEAR_FROM DATE ISSUED r�g iComplete in Triplicate) �NVIRONMENTT�AL1 HEALTH ADDllctl0on is hereby made to the Sari Joaquin Local Health Oistrici for a permit to construct andlor install the work hereirpE 3 dc��7`tYlg ication is made in compliance with San Joaquin County Ordinance No. 549 for sewage of No. 1862 for wettfpuntp and the Rules and Regulations of the San Joaquin Local health District. S-725- 1 y rJ�L GL �G Job Address y City Lot Size PM t Owner's Name...!Skiz OlfI Co Address _ ! � eJl/lw ,~ �, 76—)ql • �__.. Phone # J ContractorZUL5� /f., dress_ a 3 3 /162 6--2-2 Liernse No:�292.9 Phoneme TYPE OF WELLIPUMP: 'NEW WELL 0 WELL REPLACEMENT i J DESTRUCTION IJ ' PUMP INSTALLATION 173 SYSTEM REPAIR 0 . I . OTHER, Sart b6frnyb Onj� DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD, PROP. LINE rl r FOUNDATION AGRICULTURE WELL — OTHER WELL_ PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTAUCTIO_N SPECIFICATIONS N .. 0 Industrial ❑ Open Bottom CI Manteca Die. of Well Excavation Dia. of Well Casing ttl Domestic/Private L) Gravel Pack 1-1 Tracy Type of Casing Specifications VI,i Pubtk I:� Other � f I Delta Depth of Grout Seal Type of Grout .f I jrrlgation „�.Aplxox. Depth I I Eastern Su+face Semi Installed by-- Repair y Repair Work Done LJ Type of Pump N.P. _ State Work Done _ J I Well Destruction 0 Well Diameter Scaling Material [top 50.1 Depth Filler Material 18elow 50') ��nnJ TYPE OF SEPTIC WORK: NEW INSTALLATION I 1 ItEPAIRIADDITION i I DESTRUCTION i l INo septic system permitted if public sower is V' available within 200(eet.) rn Installation will serve: Residence Commercial—^ Other kip Number of living units: Nurnbor of bedrooms _ Character of soil to a depth of 3 feet: Water table depth ,_ �-- i SEPTIC TANK ❑ Type/Mfg Capacity No, Compartments q PM TREATMENT PLT. [I Method of Disposal Distance to nearest: Well Foundation. Property Line . I LEACHING LINE rl No. & Length of lines Y Total length/size FILTER SED ❑ Distance to nearest: Well Foundation _ Property Line _ ." SEEPAGE PITS I I Depth _. Size �.. _ _ Number ``hh I Ph SUMPS Ll Distance Io nearest: Well_. . Foundation_ Property Line — DISPOSAL PONDS 0 I hereby cartify that I have prepared this application and that the work will 1,0 done in accordance with San Joaquin county ordinances. state laws, and rules and regulations of the San Joaquin Local Health D$tricl. Homs 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 shad not! employ any person in such manner as to become subject to workman's compensation laws of California." ContrelClOr's hiring or sub-contracting signature certifies the following:-I cartify that in the performance of the work for which this permit is issued,I shall employ persons subject to workman's companea- tion laws of Calilomia." I The applicant must for all r d-Ijlspections, Complete drawing on averse side. Signed Ti ., S — Date' -3 ----e�,—i9( 1511 i. F0F DEPARTMENT USE ONLY r r .�� i r Application Accepted by Date. Arae Pit Or Grout inspection // Date. Final In/sfpecltion by Date i Additional Comment Z3 Stk 488-5781 ❑ Lodi 369-3621 0 Manteca 823-7104 ❑ Tracy 835.9385 Applicant Return all Copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 f FEE AMOUNT DUE AMOUNTREMITED RECEIVED tV PERM17'NO.INOO 13.7a tR611,1in�r 6w u.�a