ARCHIVED REPORTS XR0012563 - Laserfiche WebLink

Home Browse Search

r r ._ .._.._... ...... r60i E. HAZE i ON AVE., STOCKTON, CA Telephohe 1209)456-6781 PERK111T EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) AvNfulion is hereby mode to the Sen Joaquin Lout Neeith D;slricl for s permit 10�6nsirucl and!or install the wtirk herein described.Tris app6cmion is trade in compliance with San Joagt.in County Or&nante No.549 fur sewage or No.IAQ for trill/pump and the Rules and Figulations of trio San Josouin Local Health District. L 1 Job Address _ t� 1��ST C' e� --- Call SAM64t-% Lott Sieg` / PSN ..)wnar'allome 5�`f�i X14 haw d.. " Addro ?�' Rsol� S3Ca-T$ r.ra.•.a. G� Add;... phon.9!bl`!�1-U�tlt1 ContractorSiQ'+� �ri11�,� Ptldra3st•O-' �y 2,�lorElt�o1CA LfcenseNo. S11G1-( Phoneme 575-213 TYPE OF WELL/PUMP. — NEW WELL 0 WELL REPLACEMENT 0 DESTRUCTION Li PUMP INSTALLATION 177 SYSTEM REPAIR (3 OTHER[SOIL- 75-OZIN Gt Got-(* DISTANCE TO NEAPESr; SEPTIC TANK _ _. SEWEk LINES DISPOSAL FLO. PROF.LINE FOUNDATION _ AGRICULTURE WELL _ OTHER WETS_ PITSISUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS N/A StIt- & tAG! eAL. CJ Industries— ❑Open Bottom G rtanteu Die.of Well Excavation O;a.of Well Casing p it Domestic/Private 0 Gravel Pack 11 Tutt' Type of CaimTng__ Specifications t'I 0`146liie M.O;hef I 1 Dolts Dooih of Grout Seat __ Type of Grout��__ _._. I I litigation Apyox.DCpth I I Eestorn Surface Saul mateAdd by Repair Work Done L7 Type of Pump H.P._,.. State Work Done Wall Destruction 0 Well Diameter Scaling Material Itop 50'1 — Depth'_ _._ Fillet Material IBelowfFO) TYPE OF SEPTIC WORK: NEW 2NSSALLATION I I III.I'At'ifADDItInN I I DESTRUCTION i I INO Wpsie system permitted it public sewer is +1 available within 200 Iwt.] Installation will serve: Recidence_ Commercial Other Number of fivirn2 units:— Numbor of bedrooms _ p' Character of Goll to a depth of 3 feet: Water table dopth i _:P'0C TANK 13 TypclMfg Capacity. No.Compartrnants I PKG.TREATMENT PLT.Ll Method of Disposal Distance to nearest: Wee Foundation Prtsoem',Line LEACHING LINE 171 No.8 Length of lines_, Total length/elan, FILTER BED ❑ Distance to nearest: Well Foundation Property Line l I SEEPAGE PITSI! Depth .� Site T^_.,. _ Number 1A' SUMPS LI Distance Ic nearest: NV*Tl Foundstinn PropoatY Lina i# DISPOSAL PONDS ❑ I hereby certify that I hove ptapsred this SPO;cStion end that the work will kV dont in accordance with San Joaquin county ordinances,state laws,and rules and regulations of the San Jeequ:n Local Health Danita. !, Home owner or Itceneed agent's signature certifies the following."!certify that in the;:Aeformenca of the work for which this permh is issued.1 shad not employ any person in such rlvnner as to become subject 10 wurkman't compensation laws o1 California."Cont r cil signature f certifies the foaMW49:"I certilythul in the performance of the work for which this permit is issued,I shall empl rw L,b compante- : tion taws of CaEifomia." 4 :.i The apphicanl ust call for I eGuirad inspections,Comdota drawing on reverse aide. Signed _ Tilt.:�t v" rJ .t.7 i z -g FOR DEPARTMENT USE ONLY ! 1 Application Accepted by Date Also Pit at Grate+Inspeetion by Darr Final Inspection by Deva Addaional Comefmnts: «__ 0 SIk 4e6-fs781 ❑Lodl 369.3621 0 Mantas 1323.7104 ❑Tracy 935434 Appfk4nt•Return all copies to: Environmental Heehh Permit/Sarvicas 1601 E. Huelton Avs,.P.O.Bea 2W9,Stk.,CA MI J. lFED AMOUNT DUE AMOUNT NUMITTED C K S nECEIVOO fly DATE PEAMIT'NC. IN 13.3a tREV.I sir cog -ZL AMA da 1 1:i r1..1-1"z---4-1:2��, THE RFM0a=jnhT Or, DOCLkEW C�y� BE IMPROVE7) WE TO T I CONDITION OF THE