SU0006319_SSNL - Laserfiche WebLink

Home Browse Search

SAN JOAOUIN LOCAL 1•11EALT04 DIS—.is'„ l 1601 E. HAZEL T ON AVE., STOCKTt CA T?ibphorie (209) 466-6791 PE^.tir1T EXPIREE ' YEAR FROM DATE iSS(tED — !Complete to Triplicate) Ap '•c'ti-,i is tereby made w the Sin a. a.iuin Local Health Distrust for a permit to construct and/or fnst.,ll the work herein descrit:ed-This sOPRcatfort is made incompliance with Sa^Jo a, Co, tv Ordinance No.529 for sewago o,No. lh67 for well/pump and the Rules and Regulati Ms of the San Joaquin Local Health District. t111?-, Site J _ PM ' Jo(: Address JV) _ _ f,�-L- _L - ` Owner's Nan:�e `L _1]1_L -�+ ter `--©�t...:ss �Q-c le_s4il1J-d+1i ;}--�-'��-+ +Pt..7n^.,�..�'•1'�4L3^__ License No.-- AZ P*o ��=_ ° - --------+--r TYPE OF WELL/PWAP: NcVV WELL -1 ,'NELL REPLACEMENT 13 DESTRUCTION Ll '- --_--- PUN°INST:ALATION '_} SYSTEM REPAIR 'C OTHER 0 r I)ISIANCE TO NEARC_S'lSEPTIC aNK _- _ SEWER LINES _ DISPOSAL FCD_-- PROP. INE f ''r F^'J(JDATION - ..__- AGRICULTURE WELL ___ OTHER W LL _- PITS/SUMPS INTENCEO USE IyPE OF WELL PROBLEM.,'.EA CONSTRUCTION SPECIFICATI -NS --- - -- --- -- -- D a. of We rT.,rg ii :.1 Inclusio-I C m C Open RotioI Manteca Dia.of Well Excavation --_— T of Casing —.- --.-- Spmifcations CJ Domestic/Private C`Gravel Park C7 Tracy YTse 9- F1 public L-1 Jiher f l Delta Depth of Grout Seri __- _ Type of Grout Surfaro Seal Installed bVAPP,ox. Depth t I EasternInlanon H P. State Wori: Done Repair Work Done (.1 Type of Pump _- -_-_-_- _----- I - Well Destruction i-; Well Diameter _ _ Searing Material(top 501 f Depth _ -_ Filter Material(Below 50'I fable within 200 feet.) ,t Pub,"r sn-Wr is T ypE Of: SE DTIC WORK: NEW INSTAL E.:PION I I REPAIR/ADDITION DESTRUCTION I I nr se tic system pe p„ I t' g Installation will serve: R ,den-e:L Commercial_ Other - Numhtlr of living units: Number of bedrooms 3 _ Watrf table depth.__ .''Character of soil to a depth of feet: `��.1J /7 - No. Compartments Capacity�u LL__- SEPTIC TANK f) Type/Mfg ' Method of Disposal - PKG.TREATMENT PLT.Cl Property,Line_-_-- ti Distance to nearest: Well -- Foundation p- y L .*� LEACHING LINE [V No.8 Length of lines __L- t++------- Total length/urn._ __. - -FILTER BED C 1 Distance to nearest: Well _ _ Foundation_-. Property Line `F-! I 1 Depth -----Size gFEPA!'lE PITS - property Line SUr1P5 i 1 Distance to nearest: Well— Foundation ,.3 DISPOSAL PONDS 13 - - - hereby .`Citify that 1 have prepared this.application and that the work will bu done rn accordance with San Joaquin county ordinances,state I�ws,arrrf no rules and r,�gulat,ons of the San Joelum local Health District. )tome owner or licensed agent's signature certifies the following:"I certify that in the performance of the work fcr which this permit O issued,1 sttn-Mret ploy any n in such manner as to become subject to workman's compensation laws of California."Contractors hiring of sub cantrxtirgT sgna certifies th follovV. to ,ty that,n rh t perfon ance of the work for which this permit is issued,I shall omtley persons wbpct to workman's cort>[en a ran fa,ws CaG1ohe applir. t muall required Inspections. Lnmplote drawing on reverse side. Signed X_ - -- -- --- - T,IIo: . FOR DEPARTMENT LSE ONLY Date L,. Area Appl,cat,on Acceptod by J — —,_ -` i Date_ �- F;nal Inspection by Date �- yPit or Grout Irstxfctlon by �•� w �..-"-- 'Addi-ional Comments' -r,. Lodi 3693621 '� Manteca 8 j'104 C:Tracy 835-63A5 ' C3 St: 466 6781 'Jt. Applicant • Return all copies to: Environmental Health PermrtlServres>1601 E. Hate ton Ave., P.O. Ecx 2009, Stk.,CA 95201 rI{-FLE AMOUNT DUE :Cr _..a -_- _-- -r°- -_ DATc I INFO JAMOEINT HEh4"tE0 0 BV CH 13 24 tPEv f \- QJ - . EH.,14 26 .. . x µ.