SU0003884 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR PERMIT SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. HAZE'_TON 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. Job Address 6551 W. Arbor Rd. _ city Tracy __ Lot Size _ PM _ Owner's Name _ Danny Rocha Address _ 6551 W. Arbor Rd. , Tracy _ Phone — Contractor Hennings Bros. Address 3525 Pelandale, Mod. License No. 290813 Phone 545-1185 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION XX PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ Industrial ElOpen Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing ❑ Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications FI Public F1 Other F1 Delta Depth of Grout Seal Type of Grout 1 1 Irrigation __ Approx. Depth I I Eastern Surface Seal Installed by - ( l Repair Work Done t] Type of Pump H.P. State Work Done _ ( �` yy�yy 811 r "\ Well Destruction 'V Well Diameter Sealing Material (top 50'1 C�L� Depth 3� Filler Material (Below 50') -- TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTIO o septic system permi ted if public sewer is available within 200 feet.) Installation will serve: Residence _ Commercial _ Other , Number of living units: _ Number of bedrooms Character of soil to a depth of 3 feet: Water table depth r SEPTIC TANK L1 Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE L] No. & Length of lines Total length/size FILTER BED LI Distance to nearest: Well Foundation _ Property Line SEEPAGE PITS I I Depth Size _ Number SUMPS I I Distance to nearest: Well Foundation_ Property Line DISPOSAL PONDS I ) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin county ordinances, state laws, and rules and regulations of the San Joaquin Local Health District. "I certify that in the performance of the work for which this permit is issued, I shall not Home owner or licensed agent's signature certifies the following: ompensation laws of California.'" Contractor's hiring or sub contracting signature employ any person in such manner as to become subject to workman's c certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall em y persons subject to workman's compensa tion laws of California." The applicant must call for all required inspections. Complete drawing o reverse side Signed X Hennings Bros. By Title:C - C''� 1c- Date: 7-19-90 ORD PAR' ME T USE ONLY Application Accepted by Date r r Area i Pit or Grout Inspection by Date Final Inspection by / Date Additional Comments: ❑ Stk 466-6781 ❑ Lodi 369-3621 ❑ Manteca 823-7104 ❑ Tracy 835-6385 Applicant - Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 FEE AMOUNT DUE AMOUNT REMITTED K H RECEIVED BY DATE PERMITNO. INFO93 7 1 EH 1324(REV. EH 14.29