Laserfiche WebLink
I. <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> _ ENVIRONMENTAL HEALTH DIVISION <br /> 445 N SAN JOAQUIN, PHONE (209)468-3420 <br /> P 0 BOX 2009, STOCKTON, CA 95201 <br /> PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> (Complete in Triplicate) <br /> Application 1s hereby made to San Joaquin County for a permit to construct and/or install the work herein described. This <br /> application is made in compliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of sen <br /> :oaquia County Public Health Services. <br /> :db Address 25700 South Banta Rd CityTrarry Lot Sizer Acreage 100.83 arrea <br /> owner. Name Del Puerto Marketing Address 100 West Las Palmas Avenue, Pattertsen (800) 228 991 <br /> Contractor FugroGeosciences Adares36105 Rookin, Houston TX License No.C57556015 Phone 71 778 55 10 <br /> TYPE OF WELL/PUMP NEW WELL C WELL REPLACEMENT r DESTRUCTION G Out of Service Weil C <br /> PUMP INSTALLATION C SYSTEM REPAIR C CPT OTHER= Monitoring Well C <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLO. PROP. LINE _ <br /> FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS <br /> NTENOED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS <br /> -. ndusmai <br /> CTO n Bottom C Manteca Out. of Well Excavation In Dia. of Well Casing none <br /> Comestiv Private C Grow& Pack ;.7 Tracy Type of Casingnone Specifications — <br /> Public fl Other it Delta Depth of Grout SealMax 150 ft Type of Grout Near Cement rout <br /> I... aeon A Fu roGeosciences <br /> J Approx. Depth I Eastern Surface Seal Instilled by g <br /> Repair Work Done L: Type of Pump M.P. State Work Done _ <br /> Well Destruction C Well Diameter Sealing Material i Depth <br /> Depth Piller Material i Depth <br /> TYPE OF SEPTIC WORK. NEW INSTALLATION I i REPAIR/ADDITION I I DESTRUCTION I I (No septic system permitted it ptibec Bawer is <br /> available within 200 leaf.! <br /> Installation will serve: Residence _ Commercial _ Other <br /> Number of living units. _ Number of bedrooms <br /> Character of sad to a death of 3 feet: Water table dearth <br /> SEPTIC TANK C Type/Mfg Capacity No. Compartments <br /> PKG. TREATMENT PLT. C Method of Disposal <br /> Distance to nearest: Well Foundation Propene Line <br /> LEACHING LINE C No. 6 Length of lines Total length/size <br /> FILTER BED C Distance to nearest: Wall Foundation Property Line <br /> SEEPAGE PITS 11 Death Size Number <br /> SUMPS LI Distance to nearest: Well Foundation Property Line <br /> DISPOSAL PONDS C <br /> 1 hereby comfy that I haw prepared this application and that the work will be done in accordance with San Joaquin county proneness. state haws, and <br /> rules and regulations of the San Joaquin County <br /> Home owner or licensed agent's signature certifies the following: "I certify that in the performance of the work for which this permit is hasued, 1 shall not <br /> employ any person in such mann as to become suplact to workman's compensation laws of California." Contractor's hiring or sub-contracting signature <br /> camfies the following: "I certify that in the performance of the work for which this permit is issued, I shall employ parsons subject to workman's comoensa. <br /> Tion laws of/Califor ".. <br /> The aoplicam Af Is t c�ll I II (adios inspections. Complete drawing on reverse side. L <br /> Signed x {I/ �\"IYl`� Jam_— Title, Hydrogeologist Date: —� C� <br /> FOR DEPARTMENT USE ONLY q <br /> Application Accepted by �� t Date 4 l 0 T Area C) ` <br /> Pit or Grout Inspection be Date�—} Final Inspectio/n by L`ti oat. <br /> Additional Comments: �8"�niC+>-r /�(/�VllLty /i✓t.O�E7Cr <br /> ,ppllcanc - Return all copies to: San Joaquin County Public Health Services <br /> Environmental Health Permit/Services <br /> 445 N San Joaquin, P 0 Bos 2009, Stkn, CA 95201 <br /> INFO AMOUNT DUE AMOUNT REMITTED CASM RECEIVED BY DATE PERMIT NO. <br /> EM. 1 .iaty i,.eilloo��aa- <br />