SU0004984 SSNL - Laserfiche WebLink

Home Browse Search

PPL1C..';TiO:I FOR IE; ::jEel•'. LC-CAI HEA_TII ",-'TR,CT p H,ZLtTrla AYE. 51 TOt; k Tcl�ohone 12no1 4E6I. . F.A PE?MIT no, S/2-_ 1- :Ec":T E>.`I:tS t YEAR FAVC';.E ins';ED r DATE ISSUED ��{CorYlete In Tri pt ica.e l ascribed. is hereby Cade tv the San Joaquin Loca'. Health Cistricf `,,r a hermit to ron�tm1Ct and/Dr Instali the work herein described. This appiicatlo, is mach in compliance with San County Cr!inarc; 'aa. i•l9 and the Rules and Regulations of tt,e San aruin. Local Hfrr sewage Or No. 1862 for W7/pumpealth uistr ct. Job Address V - )h�1d Owner's Hare AdJ:ts, Phone C,Ontra[tor'S Nagle Li �- F —. -'�---- - ' cense No. —� Phone TYPE OF WELL/PUMP 1'3a• s hEW WELL ED . WELL REPLACEmEhj DESTSUCTfDN rJ i'LRi? I'Ii. "TjcLL4t1DI !ii SYSTLN P.EPF:R S il]STANCE TO NE�REST. SEPTIC TA`iK. s WER LI;1FS OTHER_ D15M.'AL FLU,. _ FRt4r. LIRE rQU'i'JA710'f i+ F-1 — _AGRICUL-URE WELL i;Tr�Eo ;;ELL PITS/SUMPS iNTEHDED glsE "_ --- _�i.------ —�— -. — _ TYPE OF WELL PFIM.LY AREA rG':STRUCTtON SC•ELTEf!.AT1;415--y IndusLrial —ULJ P�n foitoni -- — — IDOmestic/Private �-j N�nteca �..I, of Well Etcafatiun ' � I—Gravel T'p-k --1Trac I]Public -" 1-_ y ^ia. of Well Casing �j Other L, Delta Irrigation p.;prpx• I-Eastern Tv%P Of Cr.sing r [Cathodic Protection C:;,th Sp-:cifica:ivns LJ Geophysical Crptt of GrO t Seal [OtherType Of Grout �- - ScrfacF Seal Installed by s _Nu Repair Mork Gone E:1 Type Of Pu!-.p _ 11.?, State Work Done Well Destruction 01 Well Dia>reter e'lir`1 Mate-gaol(top S( ) -�— DcP[h Fill^r Natcrfa1 .;+ {94,-low T fSbC4xla- .F�7T'!T} -;S �k7.A'S).t!I�43JC'�J-JCpE�CTC�,d]C....r!�T TYPE OF c Z PPT[{ WOP.K• HEW iNSTALLATIC)N I RE Pl.In Aiifltcx[sS�)1:. - / TI04 {NO septlC tank or seepaq, pit x Installation will serve: Residence Permitted if public sewer is s{ 7- CommerCIEI _ Oth,.r available Within 200 feet.} ]cumber of living units: �� Hunb?r of bedrooms _ Lot lite ' Character of sail to a depth of 3 feet: SEPTIC TANK Type/Mfg Water table depth _ 3 PKG. TREATMENT PLT. U Type!Mfg -- Cha ci[y 1- P��'✓Ho. Compartments � h i. Septic Tank CaP'ci[y _ _ Method of Disposal :h Distance to ��earesi; Well �, C Destruction w,[ Foundation /e Property Line LEACHING LIRE - — No. 1, Length of lines FILTER 8ED — Total length/size D'istarce to nearest: WellFoundat'cn _ Property Line SEEPAGE PITS [I Depth ,at(� $tZe + SUMPS Number pr Distanc_ to nearest: IeTI Foundation DISPOSAL FMaS C Property Line mras-Zrr,ss�say�r;n. *rr"t szzzrrr: rs�ir+rr:r� z rr cr z I hereby certify that I have pre pared this app,icatlon and that the wr.rF will be J.ne in accorCanee wish San Joaquin county i7 ordinances, state laws, and rules and regulations of ll: San Joaquin Lo-:,1 Health District. ` Home owner or licensed anent's si permitgnature cert if sori": the fnttowina-: "1 cn-t'fy that in the performance of the work for which this Contra is issued, I shall not employ any person i,: such manner as to beCn;:e subject to wo-i'Mdn� compensation laws of California." Contractor's hiring yr ;uo_cantracting Signature certifies the fo)Tvwr: "f certify that i^ the performance of the work for which ,e th's pe"it is issued. I shall employ persm;s subject to work,nan's cnmC:r:;iation law; of Californiaer The applicant mutt T1 r al? rrquired Inspe tions. Complete drawing; on revcr;e stile, 3 y Signed x / Title: � Date: �� F}pstEPA"yEkT ;JcrG�rz AD �Ica:ton Acceded Dy cT 4 `L _ Are: ��Z Addi_innil cor^en[,: _ -- �! Cj Stk 456-6781 g �r+�{FPit or Grout inspect ion Lodi 369-3621 Final Tnspec[ion Manteca 823-7104 APplicant - Return all LOPieS to: Environmental };earth Permit/Serr ices }I F. ;;,, Tracy 835-6:SF _ [on Ave., P,0. 8nx 2009, Stk.. CA 95201 FEE SAS- F.r;;fjrlT irilF. _INFO ANOJ,Y`. FEMf7.iL r - �.._..` � PERMIT .w0, EH 13-24 4 I4-26 10/82 500 �,r