SU0008843 - Laserfiche WebLink

Home Browse Search

i APPLICATION FOR PERMIT I SAN JOAQUIN C0UNTX,.PUBLIC HEALTH SERVICES ENVIRONMENTAL ILEA11 TH DIVISION 445 N SAN JOAQUIN, PHONh, (209)468-3420 P O BOX 2009, •STOCKTON, CA 95201 PERMIT E%PIRE M T ISSUIM ` (Complete- in Triplicate) /lyplieatioes is hereby sade•to Bea Joaquin County for a permit to construct and/or Install the work herein described. This ayplication is cede in e®pliamee with San Joaquin County Ordins��p no. 549 and 1W,and th_er � Rules and Resulatione of S Joaquin County Pub11e Health Berries. aAM.��--7 Sj O'M-/60-7 7 lee t R-LrT✓i P- ,t'iyd, Crtyl� Lot 81se/Acreagea[G Job Addr • � Phone� Owner's Namee- • Address t Ad jContra dres act s L'+c�ease No -- o^eg� } ,TYPE act WELtfPI?MP: NEW WELL ..r WELL REPLACEMENT DESTRUCTION a Out of Service ifei.i, 'ID oTHEr� a Morias boli PUMP INSTALLA p TION REPAIR ❑SYSTEM E r ' ` r DISTANCE TO NEAREST: SEPTIC TANK._ SEWER LINES DISPOSAL FLD. PROP. LINE- s FOUNDATIONY AGRICULTURE WELL OTHER WELL PITS/SUMPS -- y INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFIC&T"$ S i?ia. of Well Cas ! �klduatrisl ❑ Open Bottom Q Nianreca Dia. of Well Excavation � E Cl Domestic')Private >iL Gravel Pack ❑ Tracy Type of Casing-pa? Specifications l M Grtwt .1-1 Pelblic t f f 1 O�har + Cl Oetta Depth of Grout Seal Xlrrigation �Approx. D th I Eastern Surface Seal Installed by Q Repair Worst Done U ' Type of Pump H.f. State Work Done ma �Q Qy Wan DaWuction_ (3Wetg DianlaUr ins Itaterial a Deptb (' ' -='*-} Oepih 1lller Materietl i DeDepth�, ;TYPE OF SEPTIC WORK: -NEW,INSTALLATION I I REP.AIRJADOITION I I -DESTRUCTION 11._1No septic system permitted if public sewer is. - available within 200 lest.$ Installition wig serve: Residence .Cemrnerei■l Other e t Number of Hvft units: Number of bedrooms ..: ,. .' Character of saR to a depth of 3 few; ; Water table depth SEPTIC TANK. ❑ Type/Mfg ' Capacity Na Compenmenta•—I PKG. TREATMENT PIT.dr Method of Di.poW - Distance to nearest: Well+�� 4 Foundetion Property Line `r A f LEACHING LINE Cl No.6 UWQtfi of 11nee Total lengthiaim hi-TER BED C Cl Distance to^@hest: Well Foundation Property Line -. SEEPAGE PITS LI Depth f ' Sia* Number i SUMPS Ll Di &WO to natinst: WOO Foundation Property Line DISPOSAL PONDS O i 1 hereby certify heat I have prepared this spplic`61W ind ihit'tlri woik-will-be done in accordance with San Joaquin county ordinances,state lbws, and rules and regulations of the San Joaquin County Home ownsr'or licansad agent's signature certifies the following: "I certify that in the performance of the work for whish this r sub- o issued.1 shah not arnploy any peraon in such manner as to bec4rne subject to workman's compensation taws cif Calilornis."Contractor s hiring or sub coneracting signature $ certifies the following:"I conify that in the peAormance of the wore for which this parmit is issued,I shall employ persons subject to workman's eompensa- tion In"of CaliforrNa... The applicant must call for all raqu Inspgctlons. Complete drawing on reverse side. S Tills: / Ila .5, - Date-- t ate:r R DEPARTMENT USE ONLY r2a=L',q �2 J All n 1 Appticatbn Accepted by 'ter �s' �`^"^a-^"'� _— Date ( _ PK or Irtspactiort by arty ..`. FinaLlnepeeftn by 1r Addklonai Comrrrnte: S i Applicant - 8et�rn all copiew-to: ..San Josquid County Public Healtb Services � Stivi-ronmeotsl Realth Permit/Services Q i 445 N Sas Joaquin. P O Box 2009, $the, CA 05201 ,' �� GS 1 E MWVNT DUE 'r —CASH AMOUNT REMITTED C"a RECEIVED OY DATE PER%AIT'NO. . ENt}Te(Rev.1 51 ��, asq Flt 1411 7D- III