FIELD DOCUMENTS - Laserfiche WebLink

Home Browse Search

APPL I fAT T GN SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 P O BOX 2009, STOCKTON, CA 95201 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) Application is hereby made to San Joaquin County for a permit to construct and/or install the work herein described. application is made in compliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of Joaquin County Public Health Services. Job Address 2 2 2 N i b L. D QraA O .S Q j�, r:�, cam, � 2` City ��'"—'-n Lot Site/Acreage Owner's Name w►2r i Caf1 �^VIV��S Address ��0 • Hat �l, 4�'�"icor phone_ h5Tb-63LF 16 a r` S1-�ckc_�4vr� //,,// �� C:i� �i 5 20,0 9//(0 ContractorGf�� %+ddress��Tr_ � _j2cj'p 373 s License No�7 ��¢ Phone //R TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT i,, DESTRUCTION 0 Out o SService well PUMP INSTALLATION C SYSTEM REPAIR C OTHER ❑ 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 f7 Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation C ir-clhrs —/ u Dia. of Well Casing fNt cf (1 Domestic/Private lNGraysl Pack L7 Tracy Type of Casing�VL- 4l7 Sa, (1Public Specificationsf"1 Other f-I Delta Depth of Grout Seal 20- 1 1 Irri atron Type of Grout U1 U' �'` _Approx. Depth I I Eastern Surface Soul Installed by F C Repair Work Done U Type of Pump H.P. tate Work OOno _ Well Destruction O Well Diameter 2' 11%C.yt Scaling Material i Depth Depth �-7 LQGt Piller Material i Depth N TYPE OF SEPTIC WORK NEW INSTALLATION 1 I REPAIR/ADDITION I 1 DESTRUCTION I i fNo septic system permrtied if public sower i _ Commercial _ Other N Installation will serve: Residence available within 200 feet.) Number of living units: Number of bedrooms Character of soil to a depth of 3 feet: SEPTIC TANKO Typo/Mfg p Water table depth PKG. TREATMENT PLT. O Capacity No. Compartments Method of Disposal Distance to nearest: Well Foundation Property lino LEACHING LINE L1 No. i Length of lines FILTER BEDTotal lengtn/size rl Distance to nearest: Well Foundation Property Lino SEEPAGE PITS 11 Depth Size SUMPSLI DiNumber Distance to nearest: Well Foundation DISPOSAL PONDS ❑ Property Lino I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin county ordinances, state lev rules and regulations of the San Joaquin County Home owner or licensed agent's signature conifies the following: "I comity that in the performance of the work for which this permit is issued, I sl employ any person in such manner as to become subject to workman's compensation laws of California." Contractor's hiring or sub-Contracting si( certifies the following; "I coitity that in the performance of the work for which this permit is issued. I shall employ persons subject to workman's torr non laws of California." The appilca t ust call for all required inspections. Complete drawing on reverse side. Signed X ( oo" nf "1`�'T1tIe: PCG�ec�F �QvtQ�p�( Data: 13 �1S FOR DEPARTMENT USE ONLY Application Accepted by Date � / l�z 7 p p � �6 °it or Grout Inspection by Date Aron Fina) Inspection by Data Additional Comments: /��Gf/-/�fZ �S' Applicant - Re rn all copies to: San Joaquin County Public Health Services ^ D Environmental Health Permit/Services ( , 445 H San Joaquin, P O Box 2009, Stkn, CA 95201 V INFO AMOUNT DUE AMOUNT REMITTED CK RECEIVED BY CASH � I E0ATEj] PERMMIIT'NO. x taEV. aini r