SU0007704 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR PERMIT SCJVNEn SAN JOAQUIN LOCAL HEALTH DISTR1CT 1601 E. HAZEL T ON AVE., STOCKTON, CA Telephone (209) 466-6781 PERMIT EXPIRES TYEAR 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 19690 North Hwy 99 CityAcampo Lot size 40 Acres PM Newport Pacific Capital Properties Corp. 369 San Miguel, Ste 385 Owner's Name Address Newport Beach, CA Phone 7.14-760-8865 2024 E. Charter 92660 Clark Well & Equipment Co. , Inc. 560 Contractor ress License No. Phone - TYPE OF WELL/PUMP: NEVA WELL ❑ WELL REPLACEMENT 29X DESTRUCTION PUMP INSTALLATIONS SYSTEM REPAIR ❑ OTHER ❑ DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES 25 r DISPOSAL FLD. 200 r PROP. LINE1 0 r FOUNDATON AGRICULTURE WELL OTHER WELL 1 0 r PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICAIJONS ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation + ! Da. of Well Casing 10 3/4" El Domestic/Private 7CKGravel Pack LlTracy Type of Casing Steel Specifications ' 1 8 R1 Public ❑ Other ❑ Delta Depth of Grout Seal 200 Type of Grout 9 Sack I I Irrigation _Approx. Depth l I Eastern Surface Seal Installed by Clark _ Repair Work Done XX Type of Pump Sub H P 30 State Work Done Install Well Destruction YtT' Well Diameter 8"n Sealing Material (top 50') 9 Sack Depth 219 Filler Material (Below 50') 9Sack TYPE OF SEPTIC WORK: NEW INSTALLATION f 1 REPAIR/ADDITION I I DESTRUCTION I I (No septic system permitted 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 O SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Well Foundation 1 Property.Line LEACHING LINE ❑ No. & Length of lines " Total length/size �tYr� FILTER BED ❑ Distance to nearest: Well "' Foundation Property Line SEEPAGE PITS l I Depth Size Number i SUMPS ❑ Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ 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. Home owner or licensed agent's signature certifies the following: "I certify that in the performance of the work for which this permit is issued, l shall not employ any person in such manner as to become subject to workman's compensation laws of California."Contractors hiring or sub-contracting signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall employ persons subject to workman's compensa- tion laws of Calif nia.' The applicant t ! or re ed c' ns. omplete drawing on reverse side. Signed x VP Clark Well 17 Aug 1988 f# Title: Date: FOR DEPARTMENT USE ONLY Application Accepted by Date _C? w Area Pit or Grout Inspection by Dat r rl, Final Inspection by �� _ Date Additional Comments: [1Stk 466-6781 ❑ Lodi 369-3621 ❑ Manteca 623-71114 ❑ Tracy 835-6385 , Applicant- Return all copies to: Environmental Health Permit/Services 1501 E. Hazelton Ave., P.O. Boz 2009, Stk., CA 95201 v FEE INFO AMOUNT DUE AMOUNT REMITTED CK CASH RECEIVED BY DATE PERMIT'NO. +.EH13-241REV.r/ks) EH 14.29 I `-' � ' J L ✓ _., .'7i 7f�r