87-74 - Laserfiche WebLink

Home Browse Search

{ s ' APPLICATION FOR PERMIT SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. HAZELTON AVE., STOCKTON, CA Telephone (209) 466-6781 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) 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. C Job Address McDonald Island City, Halt Lot Sue 885±10 acres pM 135-39-41C 375 N. Wiget Lane #130 Owner's Name Pacific Gas J Electric Address Walnut Creek, CA p6or,(415) 943-7986 .� 3400 Crow Canyon Road Contractor PGandE Address San Ramon, CA 94583 24101 (415) 20-2000 - License No. TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTIM ® Monitor Well PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHE MW-1 DISTANCE TO NEAREST: SEPTIC TANK 1000' SEWER LINES — DISPOSAL FLO. 20' PROP. LINE 80 T FOUNDATION LOOO' AGRICULTURE WELL 4500' OTHER WELL PITS/SUMPS — + INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ' N ❑ Industrial ❑ Open Bottom s ❑ Manteca Dia. of Well Excavation Tr- pia. of Well Casing 401 ~ ❑ Domestic/Private 0 Gravel Pack ❑ Tracy Type of Casino PVC Schedule 40 Specifications � h ❑ Public ❑ Other IN Delta Depth of Grout Seal Type of GroutType A ❑ Irrigation --Approx. Depth ❑ Eastern Surface Seal Installed by inter company personnel Repair Work Done ❑ Type of Pump H.P. State Work Done Well Destruction ® Well Diameter 411 Searing Material atop 50') Type A Grout Depth 122' Filler Material (Below 50'} - TYPE OF SEPTIC WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ DESTRUCTION ❑ (No septic system permitted Lf public sewer is available within 200 feet.) Installation will serve: Residence_ Commercial_ Other Worriber of living units: Number of bedrooms Character of soil to a depth of 3 feet: Water table depth SEPTIC TANK D Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. D !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 D Depth Size Number SUMPS ❑ Distance to nearest: Well Foundation Property Line DISPOSAL PONDS O 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, I shall not employ any person in such manner as to become subject to workman's compensation laws of California."Contractor's hiring or subcontracting 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 ca all required inspe5xp. Complete drawing on reverse side. Signed k Trtla: Sr. Civil Ext r. , DER Date: 6-26--86 i FOR DEPARTMENT USE ONLY r� Application Accepted by Date `- '� I area Pit or Grout Inspection } Date W Final Inspection by ` - Date 1~ Additional Comments: € M D Stk 466-6781 D Lodi 369.3621 0 Manteca 823-7104 ❑Tracy Appficant- Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009;Stk., CA 95201 INFO AMOUNT DUE AMOUNT REMITTED CASH RECEIVED BY DATE PERMIT'NO. +EH 13-M1REV.}/B41 87 �1�9a $35.00 � 3 5 , ma - S �-� 1�('-i