FIELD DOCUMENTS - Laserfiche WebLink

Home Browse Search

ane APPLICATION FOR PERMIT 0 N'N SA6N01J0 NAZENTONCAL AVEH STOCKTON, CAEALTH T CP�` � A P�� `l Telephone (209) 466-6781 kFcMENT 0 \N PERMIT EXPIRES 1 YEAR FROM DATE ISSUED E�VF� O (Complete in Triplicate) i10 A P CY F.t;i Y gA9 p��fd V�L `9 made to the San Joaquin Local Health District fora permit to construct and/or install IF��`%pj.�herein descilL5f3NJThis application is Po$21� Iompe with San Joaquin County Ordinance No. 549 for sewage or No. 1862 for well/pump and the Rp'IEA��i��ulations of the San Joaquin Loco ealth District. FN/7-- A('y RV/C�E4CTj Job Address 800 West Church Street City Stockton Lot Size PM Owner's Name Gold Bond Bldg Products Address 800 West Church Street Phone 209) 466-525_ Contractor Spectrum Exploration Address 2825 E. Myrtle Stocktoacense No. 512268 Phone_ — 712 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION I_l PUMP INSTALLATION ❑ SYSTEM REPAIR I I OTHER Ri 3 piezometers DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE _ FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS _ INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation. 8 inchDia. of Well Casing 2 inch ❑ Domestic/Private Lt9 Gravel Pack ❑ Tracy Type of Casing PUC FT Sch 40 Specifications ('I Public ❑ Other fl Delta Depth of Grout Seal 12 Feet Type of Grout 57_'Bent(?nit I I Irrigation _Approx. Depth I I Eastern Surface Seal Installed by Pump and Cement _ Repair Work Done L7 Type of Pump H.P. State Work Done Well Destruction ❑ Well Diameter Sealing Material (top 50'1 Depth Filler Material (Below 501 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 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. 6 Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Line SEEPAGE PITS I I Depth Size _ Number SUMPS Ll 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 DiMrict. 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 sub-contracting signature certifies the following:"I certify 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 Califor 'a." The applican u call for all req i ed in pe n Complete drawing on revere side. y Signed X Title: 7t`- .f Date:L/VJ/ FOR DEPARTMENT USE ONLY 1-��• '�'-' ��' � - Application Accepted by ___. Date Pit or Grout Inspection by Date Final Inspection by to Additional Comments: _ ❑ Stk 466-6781 ❑ Lodi 369-3621 ❑ Manteca 823-7104 ❑ Tracy 835-6385 Applicant - Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 IF AMOUNT DUE AMOUNT REMITTED CASH RECEIVED BY DATE PERMIT NO. EH 1324 IREV.t/x v EH H4