FIELD DOCUMENTS - Laserfiche WebLink

Home Browse Search

PAYMENT APPLICATION FOR PERMI' RECEIVED SAN JOAQUIN LOCAL HEALTH DISTRICT �0 1601 E. HAZELTON AVE., STOCKTON, CA '' JAN 2.8 1988 i Telephone 1209) 466-6781 ENVIRONMENTAL HEALTH PERMIT EXPIRES 1'YEAR FROM DATE ISSUED PERMITISERVICES (Complete in Triplicate) Application is hereby made to the San Joaquin Local Health District 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 for sewage or No. 1862 for well/pump and the Rules and Regulations of the San Joaquin Local Health District. Job Address 1014 North Eldorado Street City Stockton Lot Size 150' x 150' PM Owner's Name . Budget Car Rental SaleSAddress 10111 N . Eldorado St. , Stockton Phone (M)941-0434 5729-F Sonoma Drive Contractor BSK E Associates Address Pleasanton, CA 94566 License No. 490942 Phone 415) 462-40 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ PUMP INSTALLATION ❑ SYS1TEM REPAIR ❑ OTHER q( Soil Boring 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 C7 Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation ❑ Domestic/Private ❑ Gravel Pack ❑ Tracy Type f Well Casing ype of CasingStem Specifications f'i Public (XOtheSoil Boring Delta o Depth of Grout Seat 15 to 2p+ I I Irrigation 20—'+ —•- Type of Grout�(eOt C'Pm� 20._ Approx. Depth I I Eastern Surface Seal installed by Repair Work Done Q T I '• H.P. Type of Pump State Work Done Well Destruction ❑ Well Diameter Sealing Material (top 50'1 Depth " Filler Material (Below 561 TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I iNo septic system permitted if public sewer is Installation will serve: Residence_ Commercial Other available within 200 feet.) Nomber of living units, Number of bedrooms Character of soil to a depth of 3•,feev SEPTIC TANK Water table depttf ❑ Type/Mfg PKG. TREATMENT PLT.'❑ CapacityNo. Compartrrx! is f Method of Disposal Distance to nearest; Well�,` Foundation Propert* Line LEACHING LINE ❑ No. & Length of'Erneo _ . FILTER BED Total length/size ❑ Distance to nearest; Well Foundation Property Line SEEPAGE PITS 1 I Depth Size SUMPS - Number I Ll Distance to nearest: Well Foundation ,DISPOSAL PONDS Cl0 , .. ProPerty Lina 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 District. 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 subiect to workman's compensation laws of California." Contractor's hiring or sub-contracting signature certifies the following:"!certify that in the performance of the work for which this permit is issued, tion laws of California." I shat)employ persons subject to workman's compensa- The applicant must call for all required inspectigns. Complete drawing on reverse side. Signed L(/ Tine: Manager -- Engineering Date: 01/25/88 FOR DEPARTMENT USE ONLY Application Accepted by Z/(�Ary Date Area Pit or Grout Inspection by Date Final Inspection by `� Dated Additions! Comments: � _ ❑ Sik 466-6781 0 Lodi 369-3621 ❑ Manteca 923.7104 ❑ Tracy M6385 Applicant- Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 FEE INFO AMOUNT DUE AMOUNT REMITTED RECEIVED BY DATE PERMIfi'NO. • EH 14-24IREY.ffnyl - - EH 14-26