SU0012822 - Laserfiche WebLink

Home Browse Search

•�- APPLICATION FOR:PERMIT SAN JOAQUIN LOCAL HEMI.TH DISTRICT 1601 E. HAZELTON AVE., STOCKTON; CA ?. Takolom M)48646781 PERMIT EXPIRES.1 YEAR-FROM;BATE ISSUED' M, �;(Cvfnpkfls in 11`rlpFtcatal:, _ �: i pn Application In hereby made to the San Joaquin Local Heandr Dbffld for a pm id to conrtruet and/or Install Urti work fob dascrlb.d.This POP dii le `a made in compile. vrhh Sen Joaquin County Ordinance No.dO for sewage o No.11M,fa►well/pump and 1M Rulas end Raga VOM of tM Sen Jeaqukn LoNot"Oiatrict. 3• e J 01-0W 9Sia' 'La'�L I eR �dt 6 Job Address �y- I : Owriet',Nemo L Addroas .�► � d ___' Rom �� Contractors Name _ t lanae NO. - - Pirate TYPE Of WELL/PUMP: NEW WELL ❑ WELL REPLACEIMENT�O DESTRUCTION ❑ w PUMP INSTALLATION ❑ SYSTEM REPAIR 0 � 'OTHER ❑ DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLO PROP.UNE FOUNDATION AGRICULTURE WELD:L *." OTHER WELL-" PITS/SUMPS '14iNTENDEQ USE TYPE OF WELL y PR08LEM AREA CONSTRUCTION SPECIFICATIONS : s (� x L7 IndustriM o Open Bottom a Manteca m Old.Of well ExsvYtlon' Di.of Wall Caaft �I ❑DamesticlPriveta ❑Gravel Pack ❑Tracy Type Of r'asing., Spsctlacatlorta ❑Public ❑Other ❑ Delta Depth of Grout Seal Type of Grout O ❑Irrigation __Approx. Cepth ❑EazW Surfm*Seal Instilled by Repair.Work Done ❑ Type of Pump H.P. State Work Dene Wed Destruction ❑ Well Diameter Sea"Mate"Itap 671' Depth Filler MVWW(Below 60'1 TYPE OF SEPTIC WORK: NEW INSTALLATION REPAIR/ADDITtON❑ DESTRUCTION❑ (No at systtrn N Public sswar is avadal�ta wigin 1 . Inaunation will serve: Residence Z Commercial— Other ' Number of laving units: Number of bedrooms Chmacter of soll to a depth of 3 few: Water table depth SEPTIC TANK Er '6pa/Mfg Capacity No.Compartments PKG.TREATMENT PLT.Q . Metfgd of D�qis�p.os�al k Distance to nearest: Well.�_ Foundation X 41 Property line / LEACHING LINE ;6—No,8 Length of lines 3 — X10 r Total kngth/ i ' -FILTER RED ❑ Dh:tanee to nearest: Wed-&L— Foundation &Z _ Property Line SEEPAGE PITS d Depth , o2S' Sloe ^ tlumer b SUMPS Cl Distance to nearest: Won_7.75 foundation .10_ Property Line ,A2.2�_^ s DISPOSAL PONDS ❑ I hereby certify Hunt I have prepared this application and that the work win be done In accordance with San Joaquin county ordinances,state laws.and rules and regulations of the Sen Joaquin Local Health District. Horne owner or licensed agent'a signature oertifise the following:"I certify that In the performance of the work for which this permit is issued,I shin not employ any pin In such manner as to become subject to workmen's compensation taws of Canfonia."Contractors hiring or subcontracting signature ` eartlFia the following:"I certify that In the pedomianee of the work for which thio permit is issued.I shed employ ri" subject to workmen's cornpense- i �3 tion lows of California." i. The applicant m can for al ulred inspections.Complete drawing ontide.} r Slgnrad Title: /Yo I�. lf'.._4, DOW r FOR D ARTMENT USE ONLY ' Application Accepted by Date 1.2 Area ' 1 1-201, Fit or Grout Inspection by Due Final Inspection Data ' I Addldonal Comments: r s J 7 ❑Stir 4116-Ml Pe6cfi 389.3821 ❑ Manteca 623-7104 ❑Tracy s? SWIM Applkant-Retum ad pies to: Environmental Health Permit/Servieee 1601 E. Hazelton Avg§., P.Q. Box 2009,Stk.,CA 95201 Ix INFOAMOUNT DUE AMOUNT REMrTTEO CASH RECEIVED BY DATE PERMWNO. .EN13-MMev.IWO �S (o73 N� 13-r3�i �y-Isis n+ossa }f ,'t�yt Y r• f � tel `. ,. d 7°cru.A 1T , ri r � � x