ARCHIVED REPORTS XR0012749 - Laserfiche WebLink

Home Browse Search

L APPLICATION FOR PERMIT SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICR. PAYMENT ENVIRONMENTAL HEALTH DIVISION RECEIVED 1601 E. HAZELTON AVE. , PHONE (209)46F%-:!420 Q p o Box 2009, STOCKTON, CA 952-^i JUN 0 0, 1990 a (Complete is Triplicate) �l�PlY"d��'� I SERVICES ApPlicat is hereby made to Bea ,Soaquia County for a permit to construct and/or install the work h n scribed. This • aPPlicatioo it sada in ecepllahto with Bis Joaquin County Ordinance No. 549 and 11362 and the Rules and itegulations of San Joaquin County Publle Health Barricear Job Addre City LII / 1�) .�'C"kev �+..{, .-d. Lot Site/Acreage ss Owner's Name Gk�� lala Address _Iofi Qp Fox 724 b- Conhactor CLJ_tk: Atfdidii sb License No, Phone S= TYPE OF WELL! UMP: NEW WELL 11WELL REPLACEMENT Q DESTRUCTION Li out of 9ervica ,fell CT PUMP INSTALLATION ❑ SYSTEM RF,PAIR ❑ OTHER.❑ Monitoring Well- DISTANCE To NEAREST: S011C TANXtiA'-- SEWER LINES ' r DISPOSAL FLO. &M: PROP.LINE"_ �C FOUNDATION 3 -AGRICULTURE WELL _OT14ER WELL AVA Ai LriTS1SUMPS &A INTEUDED USE TYPE OF WELL PROBLEMAREA CONSTRUCTION SPECIFICAT NS `rr E7 Industrial ❑Oport Bottom ❑Manteca Dia,of Wen Excavation__ Dis.nl Well Casing i•1 Domssticiptivate KGr@vel Pilch ❑Tracy Type of Cuing PVL s J+• /D S nutations -Slat I'I Public I.1 Other ❑oait@udr Depth of Grout Seel LdbO� ��rout C�iaMrhy�4'•rf I I Irrigatlon -WApp,os.DeptH I I Eaflam Surface Saul Installed by dDITUM r Repair Wath non! U Tyg1 al Pump H.P. _State Work oneA WON Destruction ❑ war Olamefs Beeling trill i Depth r Lill SKSk,,1dm O Depth -�f�-4JAfiller Hatarial i Depth _ TSrPE OF SEPTIC WORK: NEW INSTALLATION 1 I REPAIR/ADDITION I I DESTRUCTION I I IP40 Septic lysiem permitted if public fewer is 6 availabte within 200 feet.l Instanatbn maul nerve:' ReWlInce_ Cattutleaw— Othar Number of ovirta uNiA.- Number of bedrooms Charectet of ser to a depth at J feet: Water table depth SEPTIC TANK 0 Type/Mfg Capacity No.Comoartrnenti PXG.TREATMENT PLT.❑ Method of Disposal M Dhttance to nlsrest: Wen Foundation Property Lina 1 LEACHING LINE ❑ No.A Le filth of lines Total length/size " FILTER BED ❑ Distance to naaust: Well Foundation Progeny Line I� SEEPAGE PITS I I Depth Size Number _. SUMPS LI OistirK4 Its neared: Wall FouncHfon Property Line r DISPOSAL PONDS ❑ . Ir I hereby c4rtify that 1 haw preparid 11416 applk:attb s and that the wotg will.be done In accordanrfi with San Joaquin county ordinances,stale Itws,and rules and rapufations of the San Jbequln CdwtT ' : Hama avvner of Ik*dod 6Wt's gnatdte 4n41lle!the foil rMng:"I coitify that Ih the performance of the work for which this permit is Issued.I shall not employ any parion In such mintier as Id becbme lubladt to worktna'a conipsnsetlon lawn of CaGfornla."Contractors hiring or sub-contracting signature certNlN the following:"I cartify that In Ifte patfotrtiince of the work Ito+which this permN is issued.I shall employ Persons subject to workman'@ compensa- lion laws of CWfornia:, I -I I I The applkini bruit Car for ed riquk d IhtpACtWA.Caltlp+,Ie !resew g on fw@re@ tads. Title:-- Dan: RR n BE ONLY R y Applkilkm Accepted by Data Area d Pit or Grout Impaction by _Data 4L" Final Inspecilon by Data�----- Addlilon@l Comments: r I Applicant- RaWrra alt copra tole Sin Joaquin Cc=tl+ Public Health fiersides, hwironwat:al BCllt:6 PAri It/8ervicea 16011. Blisolton Ava., P 0 Box.009. Stockton, CA 95201 FE! AMOUNT OUS I AMouNt nwrrEO CK# RECEIVED By OATE PERM1T'NO. INFO CASH fN lore