SU0011506 - Laserfiche WebLink

Home Browse Search

i APPLICATION FOR PERMIT, SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. HAZELTON AVE., STOCKTON, CA Telephone (209) 466-6781 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (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. {I Job Address ��.� �y/�/ ��/..�� /^ City 04 {�.- Lot Size 70 /S� r PM I [�-d�N Address �+' 4!ke " 01Z Phone 11 Owner's Name -Y 7 r�—�— I Contractor �l� '[ Atltlre55 � .r� �fOCf /'�/O� License No.,3 Phone ?6aW3j TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ t . ( PUMP INSTALLATION.,g- SYSTEM REPAIR ❑ OTHER ❑ DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE _ t } I FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS _ _ INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ( a ❑Industrial Li-opt, Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing ❑iDomestic/Private ❑ Gravel Pack ❑_Tracy Type of Casing Specifications r 1 (1'Public fa Other fl Delta Depth of Grout Seal Type of Gtout_ kI I irrigation —.Approx. Depth I I Eastern Surface Seal Installed by ' - I Repair Work Done ❑ Type of Pump H.P. State Work Done I u WellDestruction ❑ Wall Diameter Sealing Material (top 507 1 Depth Filler Material (Below 507 TYPE OF SEPTIC WORK:- NEW INSTALLATION KREPAIR/ADDITION I I DESTRUCTION ( I INo septic system permitted if public sewer is available within 200 feet.) Installation will serve: Residence ✓ AW-' e' Commercial Other afA•i 7 ' Number of living units: i Number of bedrooms_4 o .Character of soil to a depth of 3 feet: 15,41419 *'+V Water table depth 7L 7 f `SEPTIC TANK O"Type/Mfg Le"6'A Capacity h040 V No. Compartments 2 'PKG. TREATMENT PLT.❑ 4faNE- Method of Disposal t Distance to nearest Well Foundation V Property Line LEACHING LINE Ctko. & Length of lines S- z"^4`S t ! Total length/size O FILTER BED ❑ Distance to nearest: Well Fodndation Property Line ^ t� n SEEPAGE PITS 14-Depth da4T 1/^ Size 7 Number SUMPS 0 Distance to�near�st: Well 170f4s Foundation 1 /001 Property Line DISPOSAL PONDS ❑ I hereby certify that I have prepared-tnis)application and,that the work will.be'dbne in,accordance with San Joaquin county.ordinances, state laws, an ' rules and regulations of the San Joaquin Local Health District. . HL owner or licensed agent's signature canities the_tiftlbwing"II certify that,in the performance of the work for which this permit is issued, I shall m e4loy any person in such manner as to become subject to workman's compensation laws of California."Contractors hiring or sub-contracting signator ' ce ifies the following: "I certify that in the performance of the work for which this permit is issued, I shall employ persons subiect to workman's compens; s tion laws of California." 11 1 r Th�applicant must call fo all r quired inspections. Complete drawing on reverrsee aside. I e ' 1 �t 'J' Signed X _ Sit1e; L�cO:Nr1 `1.f Date: I f r �,�'.. FOR DEPARTMENT USE ONLY ;J �j Application Accepted by 7 'J,/ - Date Aree t �t'or Grout Inspection by �rn a e..J 'r �� .incl Ins_oection by Date VVVVVVAd�d`ltional Comments: 1 ❑�tk 466-6787 ❑ Lodi 369-3621 ❑ Manteca 823-7104 ❑ Tracy 83543385 ApoY scant - Return all copies to:.Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Boz 2009, Stk., CA 95201 INFO T AMOUNT DUE A%A3UNT REMITTED • C K 11 RECEIVED BY DATE PERMIT'NO.