FIELD DOCUMENTS - Laserfiche WebLink

Home Browse Search

APPLICATION FOR PERMIT S OAQUIN COUNTY PUBLIC HEALTH S VICES ENVIRONMENTAL HEALTH DIVISION 1601 E. HAZELTON AVE. , PHONE (209)468-3420 P O BOR 2009, STOCKTON, CA 95201 PERMIT EXPIRES 1 vDan r rR M DATE (Complete in Triplicate) Application is hereby made to San Joaquin County for a permit to construct and/or install the work herein described. This Joaquiapplicn Con Se made in coerpllnnce with San Joaquin Count Joaquin County Public Health Services, y Ordinance No. 549 and 1862 and the Rules and Re Job Address Corral Hollow Rd. Regulations or sen (See sit (Mr. Paul Verma) e len) Owner's Name city Trac-_y_ Lot Size/Acreage 9.17__, Acres_ City of Tracv Address 520 Trac B1. Trac CA 95376 Phone 209 836_ 4`. Contractor Ma¢Qiora Brothers Address596 Air ort B1. W ryille TYPE OF WELLP-U License No.249957 NEW WELL WELL REPLACEMENT ❑ PhoneL40$ 3 -$22 PUMP INSTALLATION ❑ DESTRUCTION ❑ Out of Service Well ❑ DISTANCE TO NEAREST: SEPTIC TANK N ASYSTEM REPAIR Ll OTHER ❑ Monitoring Well SEWER LINES NIA DISPOSAL FLD, PROP. LINE FOUNDATION N A AGRICULTURE WELL NIA OTHER WELL NIA INTENDED USE TYPE OF WELL p PITS/SUMPS NIA fl Industrial ROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ Open Bottom ❑ Manteca "'--a'Well Excavation rr I 1 Domestic/Private �Gravel Pack $ Dia. of Well Casing Arr [�Tracy Type of Casing 41, c h /n Il Public Il Other ❑ Delta Specifications__ I I Irri ation Depth of Grout Seal T 9 r U' ..Iof Pu . Depth I I Eastern Type of Grouter Repair Work Done U Type of Pump Surface Seal Installed by H.P. _ Well Destruction ❑ Well Diameter Sealing Material & Depth State Work Done Depth Filler Material 6 Depth TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/AD-1710N I I DESTRUCTION I (No Sept ic system permitted it Public sewer is , ice r"�- -. ,7 available within 200 feet.) Installation will serve: Residence_ Com rciaj_ Other Number of living units: _ Number of Character of soil to a depth of 3 feet: Water table depth SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments PKG, TREATMENT PLL ❑ Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE ❑ No. &Length of lines Total length/size FILTER BED O Distance to nearest: Well Foundation Property Line SEEPAGE PITS Q Depth Sire Number SUMPS O Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ 1 hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin county ordinanc rules and regulations of the San Joaquin County as, state laws, and 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, I shall employ persons subject to workman's compensa tion laws of California." The applica ucall for Ixequired inspections. Complete drawing onarse sid Signed X U Title: _ Date: it Application cri ted b !/ F PA T USE ONLY A P y -T C Date as — /Area Pit or Grout Inspection by Date Final Inspection by Date Additional Comments: Applicant - Return all copies to: San Joaquin County Public Health Services, Environmental Health Permit/Services 1601 E. Haselton Ave., P 0 Box 2009, Stockton, CA 95201 FEE INFO DUE AMOUNT REMITTED CK RECEIVED BY nINFO7CASH.y GATE PERMIT'NO. EH 4.25(REV. asi V ltd" .'-C'G'f/ �-- �;�5• �� /- 1