FIELD DOCUMENTS FILE 1 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR PERMIT •;AN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. HAZE VE,VE. STOCKTON , CA Teh )pOond *,T'NII 7�, WW1 PUBLIC HEALTH SERVICES PERMIT EXPIRES 1 ' YEAR �ROIVI �II7A��IIDIVISION ( Complete in >s IAL PERMIT Application is hereby made to the San Joaquin Local Health District for a permit to construct and/or install the work herein described. This application is made in compliance with San Joaquin County Ordinance No. 549 for sewage or No . 1862 for well/ pump and the Rules and Regulations of the San Joaquin Local Health District, Job Address 1045 W . Charter Way City Stockton Lot Size PM Owner's Name Nomellini Construction Address 939 W . Charter Way Phone ( 209 ) 465- 3956 Contractor Spectrum Address 2825 Myrtle St . , Stockt00en3e No. C57512263 Phone ( 209 ) 948 -1345 TYPE OF WELL/ PUMP: NEW WELL IX WELL REPLACEMENT ❑ DESTRUCTION �,❑ PUMP INSTALLATION El SYSTEM REPAIR ❑ OTHER X m t-`"`a t/4-alk' DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE4f' fJ' FOUNDATION AGRICULTURE WELL OTHER WELL PITS/ SUMPS _ INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ Industrial ❑ Open Bottom Cl Manteca Dia. of Well Excavation gtt Dia. of Well Casing 211 ❑ Domestic/ Private N Gravel Pack ❑ Tracy Type of Casing PVr RC'h - 40 Specifications cement / benIDni 11 Public ❑ Othaeerppl ❑ Delta Depth of Grout Seal 151 Type of Grout slurry ( 3 ) 'itIrsa9atian Monitoring--Approx. Depth l I Eastern Surface Seal Installed by Slartrnm _ Repair Work Done ❑ Type of Pump H . P. - State Work Done Well Destruction ❑ Well Diameter 711 Sealing Material (top 501 Depth 401 Filler Material ( Below 501 TYPE OF SEPTIC WORK : NEW INSTALLATION ❑ REPAIR /ADDITION 1 I DESTRUCTION I I (No septic 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 PKG, TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Well Foundation Property . Line LEACHING LINE ❑ No. & Length of lines -Total length/size FILTER BED ❑ Distance to nearest: - Well Foundation - Property Line SEEPAGE PITS II Depth Size 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 Local Health District. 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, 1 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 C 1Hornia." The applies u call for all &red inspections, omplet drawing on reverse 'de 04II . / rQSigned rr ASS rl Title: _ (- ( S Date: / ( 2w / l� yCceipted FOR DEPARTMENT U S E ONLY Application by /r Date �l � � � Area i✓I ell t � M `U.?— 2 S � . �-� c, Pit or Grout Inspection byIW,,,�%/]/J ,Date J ( '` Final Inspection byp _�" ` v� Date / Additional Comments: w -�' Jo ` �Z /&`'`' � � � ❑ Stk 466-6781 ❑ Lodi 369-3621 ❑ Manteca 823-7104 ❑ racy 835-6385 Applicant - Return all copies to: Environmental Health Permit/ Services 1601 E. Hazelton Ave., P.O. xBb 2009, Stk., CA 952 FEE� .� INFO AMOUNT DUE AMOUNT REMITTED CK CASH RECEIVED BY DATE PERMIT' NO. / Az/ m AI C;t `�- 3/ CD � EH 13.24 IREV. 1 / x 5) EM 14-Ze