FIELD DOCUMENTS - Laserfiche WebLink

Home Browse Search

APPLICITTON . SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 P 0 BOX 2009, STOCKTON, CA 95201 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) Application is hereby erode to San Joaquin County 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 and 1862 and the Rules and Regulations of San Joaquin County Public Health Services. DDRW-Tracy, 25600 Chrisman Rd city Tracy Lot Size/Acreage 448-acre Job Address DDRW-Sharpe, Roth Rd. Marshall Cloud Owner's Name Defense Logistics AgencyAddreea Lathrop CA 95330 Phone (209)982-2086 1202 E. Kentucky Avenue Contractor Water Development Address Woodland CA License No.C572533Z/yPhone (916)662-28 9 'YPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ Out of Service Well ❑l PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ 4 Monitoring Well DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLO. PROP. LINE _ FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS _ INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS 4 In ❑ IndusVlDl ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Tl Dia. of Well Casing Type of Cl Domestic/Private ($Gravel Pack IXTracy Casing- 40 VC Specifications Rah 40 9- SC8 11 Public 1-1 other f_1 Delta Depth of Grout Seal 70 - 115 r Type of Grout Portland II I I Irrigation _Approx. Depth I I Eastern Surface Seal Installed by Water DeyelODment__ Repair Work Done U Type of Pump H.P. State Work Done _ Well Destruction ❑ Well Diameter Sealing Material a Depth Depth Filler Material i Depth TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I (No septic system permitted if public sewer is available within 200 last.) Installation will serve: Residence_ Commercial_ Other Number of living units: _ Number of bedrooms Character of and 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. B Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Line SEEPAGE PITS 1 I Depth Size Number SUMPS LI Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ 1 hereby cenify, that I have prepared this applicatwn and that the work will be done in accordance with San Joaquin county ordinances, state laws, and rules and regulations of the San Joaquin County Home owner or licensed agent's signature canifies the following: "I cenify 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 canities the following: "I comfy that in the performance of the work for which this permit is issued,1 shall employ persons subject to workman's compensa- tion laws of California." The applicant_must cal ILrequirrW-iw actions. Complete drawing on reverse side. Signed Title: Project Manager Date: 5/20/93 FOR DEPARTMENT USE ONLY 9 9 C� Application Accepted by ` Date S ` Area Pit or Grout Inspection by" LZ(: Data Find Impaction by '�' o^-'c'd Date �/v Additional Comments; Applicant - Return all copies to: San Joaquin County Public Health Services Environmental Health Permit/Services 445 N Sao Joaquin, P O Box 2009, Stkn, CA 95201 1. FEE AMOUNT DUE AMOUNT REMITTED CK RECEIVED BY DATE PERMIT NO. INFO ( /n� '_C]AKst ///��,,,,,,///��t TQ CU (r� EM 13.24 IeEV.1,.e1 �vl O 0 �� °= 1 1 O to`1 � s 1, 0193 LJ ' 0