SU0003666 SSNL - Laserfiche WebLink

Home Browse Search

:iAN JOAQUIN LOCAL HEALTH D IrT :601 E. HAZELTON AVE., STOCKTON.!. Telepftont: [2091 456.6781 ' ' - J.' PERMIT EXPIRES 3_YEAR FROM DATE ISSUED .—_—_---._--(Complete in Triplicate) Aprr!tcanon is herehy n:ad.:to:he Sen,.,:rgUm Loc.v Hya;th f5:rer,_;la:a p.vmit:o constracr a�r3 rr-54f tr+e-wk herein described.This application is made in compliance with San Jpanu:<:-puny Orda.ance Nu.549 to,sewage 0-140. 1&.-a for wort puma and:he Ru!rs cod Rnpulaiiors of the San Joaquin Total Heal;h DisUic:. - JobAdclmss /..7.(' i L2e �t_.._�1,�.._lt'�i C+tT ._ ., / LorSizc_.._-----__- Pfl___. Ovrner's N:,mn�CrJ11;i__._J'rl_i?r'_T rN. Phcnr �l7-t�y73__ _ Contractors 16me _ - .... t _.. N. ' ` . Phone - TYPE OF WELLiPUMP: NVW eVEI,L :'JELL P.EPLACFkiFWf_. DESTRUCTION - -- ...._.�._,._-,�__._____ PrJMP INSTALLATION ✓ SYSTEM REPAIT! - OTHER DISTANCE TO NEAREST: SEPTIC TANK -., .- SEVER LINES _.--, -_ DISPOSAL FLD , PROP. LINE FOUNDATION -. AGHICU.T;JRE WELL OTHER WEii..., PITS.'SUMPS 114 INTENDED USE TYPE OF WELL PR06LE!A AREA CCNS'RLIC ION SPECtx1CAT10 JS ! � I��ndusu:al _. Open 9Uttnrn Sdanteca D a.p.'bN_i E�cawron Weli Casing i✓1lomestic�Private 1..Gravel Pack Tracy Ty of Casing-___- \ - . pe _-_ ...-'-_-.__-_.. Specihca[ions Fublic i:'Other ' ', Dvh.: Depth or Grout Se ---- Type cf Grout--- '- Irrigation .--Approx..Depth Easterr 'Surface Seal Irrstartod Repair Wark pone Type o'Pump�tl� _._ H.P-J S",e VVotk Done - Well Destruction F, Well Diameter _�� Searing N1a:eria!trop 50-: �� C Depth-_a2Z1y.. .._.____.,_. Finer h1werial(Below 50.1 TYPE OF SEPTIC WORK: NEW INSTALL P.TION;-. REPAIR:ADWT!ON(.. DESTRUCTION INo'eOvm system permit,ad if peitrtc sewer is available within 200 feet) InstaDation will serve: Residence— Commercial. Other___ -_—_- _Number of living units: _- Number of bedrooms._._.--. - PAYMENT Character of soil to a depth of 3 feat; —_ ____- -._.Water tab]sdrpN+�ri�.! SEPTIC TANK i7 Type;fvtfgCapacity--._-.,______.._ ale.CompU� �E�n`nss '�r PKG.TREATMENT PLT.iY Method p1�Ctis�,JIbs� !C�;l____ �] - Distance to nearest: Well Property LineSA.P.„J.r`y Uii`,j C;C)iih �1' -LEACHING LINE No.8 Length of lines - - FILTER BED t; Distance to nearest: Well_ Foundation Property Lino -_ - - SEEPAGE PITS tC Depth _Size_ -_ Number - SUMPS 0 Distance to nearest: Well-�-: Foundation -� 'Prr perty Line_�- DISPOSAL PONDS 1 hereby certify that I have prepared This application and that the work wiil be.done in accorCance w�th 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 fallowing:"I ce;tify that in the performance of the work for which this permit is issued,I sh0 not employ any person in such manner as to became subject to wC•kman's compensation laws of Car!ornia.• Cortractor's hiring of sub-contracting signature certifies the following:"I certify that in the performance of the work to,which this permit is+ssued.I shall employ persons subject to workman's compensa- _ tion laws of California." 1 The applicant must call for-J required L inspections. Complete drawing an reverse side. - �. �_. Title: �1, r.,�....-�:5.�� Date: FO HEPAR frNT US NLY 's - - . A lication Acce ted b ' r .+r Dat AP p Y _s�� _._, a F 'r( r t Inspection 5• Date Final ins n Pit or G ou spec o ._ pectro by fAdditional Comments: --__ _ is Sik 466-6781 !J Lodi 369-3621 (;Mantera 623-7104 G:Tracy 835-6-at5 1 Applicant-Return all ropins to:Environmental Heatth Permit/Services 1601 E.Hazolton Ave.. P_O. Box z'om.Stk..CA 45201 FEE AMOUNT DUE AMOUNT REMITTED t'Sp RCCEt',tED BY DATE PERMFr'NO. INFO a FM 13-2.Mliv,tar>Q}04 26 r