SU0002215 - Laserfiche WebLink

Home Browse Search

/VOTE: -FH K" p6x M"`1r►S SAN JOAQUIN COUNTY PUBLIC 11F.ALTH SP,RVICES 1 Is r` DEEP ENVIRONMENTAL HEI LTH DIVISION 5011_ L'�OR/r! 5 445 N SAN JOAQUIN, PHONE (203)46,$-3420 APR p 9 1992 FJ �a P o Roa 2009, STOCRTON, CA 95201 rJk�R��lL WASTE /5 FNVIRONMENT.AL HEALTH+ RPEC_,CD 7n PFrt1dIT E%PIRFS 1 YFAR FLOW DATE ISSiJE1) Pf.H�t'I�fSfHVI t7 (Complete In Triplicate) Application Is hereby made to baa JoaQuin •ounty for A permit to construct and/or inst u the work herein deaertbed. This application is Made In eeepllance vlth eau. JoaQutn Cow-ty Ordinance 110. 549 and le62 and the Rules and Regulations of Ban JOa4uin County Publit Health Ser/vteeo. '/ � Job Address 7 3e� /r4R A!.�e�N/b r/ `�qq Gtv_AL2nTD0 r !�•5 <e I 1�_�_�. Int Yl:e.AereAga D�v,.�dil. s,n !t )?d.Boe' 7&07 Owner's Nama Address EAST Ruri4j!r 2D„Ll/TC77073 Dhone�0/ 1?_�3-02L s ;L 5�)7 Fec;r-10 57(ZfIc j C67 (209)718^702/ Contracla --Address�FKf srr0 C4, ."93721 L cense No $O(vl�J9 Phone TYPE OF WELL/PUMP' ,U NEW WELL 0 WELL REPLAt,Eetf NT ('1 DESTRuCT10N Ll Out of Service Yell MP INSTALLATIO Q SYSTEM.AEP�LIR C7 OT ffl n Monitoring Well n DISTANCE TO NEAREST: SEPTIC TANK - SEWER LINES �,^ OtSPOSAL FLD. ff PROP. LINE 7 I FOUh )ATICN i�`=_ AGRICULTURE WELL OTHER WELL_ PITS/SVMPS N INTENt7ED use n TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ONS Industrw j O 0 om 0 Manteca Du of win E■cavarion Dia.of Wan C ling r DomeaGe/Prrvata O vN Pack I' li Tracy Type of Casing___ Speuhuuons -- 0-_.e... t 1'1 Frlblie f l her // l Delta Depth of Grovr Seal ��__- TYpe of(it 5_ [ 7 I I ktigat;0P pros. G� I Surface Seal Installed by Rapsw wort Dons U Type of /` Sue Wert Done 1 W94 Destruction Q Wan Oumaur ts. )Martel i Depth 1/ f!z ller M al i Depth t DepthTYPti SEPTIC WORK. NEW INS tat uLnO!'t I Nc rAOD I t TRUCTION 1 I INOtepee erNem permrhrd d lrt g pubvvM Gr i available—thin 200 Iest.1 _ Installation VA at": Pe"on"_, Commercial„ Other { Numbt of L'ving uMta; Numt»•of bedrooms Charettef of visa to s depth of 1 trot: Water table depth SEPTIC TANK O Type/Mfg Capacity No.Compontrvnu PKG.TREATMENT PLT.O Method of DipoW Distance to nearest: Wan Foundation Progeny Lona —i-- - e 9 LEACHING LINE L1 No.1 Longtn of Ghee _ Total sen2th/slro ! FILTER BED Q Distance to neerest. Wen Foundation _. Property Line SEEPAGE PIT. j 1 1 Depth —Sri* Numbe• I SUMPS i ll Distance to-stress Well Foundation _ Property Lone DISPOSAL PONDS O l i haraDy eartlfy,t13l I f1MW prepared this cep ollutron and Inst the work will be dune In accordance with San JoaOuln county ordrnanees,state Iowa. and s and regtdetronaofthe San Joa¢u•n Ho"Ow.,oar Or I*AW agent's signature MM4,es the following:"I costly that in the performance o'the work for which this permit is issued,l OUR not employ any person in atjth manner be to b&:ome subject w workman's compenestion laws^l Cali►urnu.'•Contractor's hiring o/wD•conrr:sing sipnsluq + _ i urtitiH the following: etrilly that in the aAormsnca o!ma wool,for wrveR.No permit is isswd.I shall employ persons subject to workman a e^.!npM/1• tion tewe of CaGfaNa: ` The applieanl mu►t enZu kad ispaction mp;eu drawing on�rvsrse 6,310. Signed X_� L�Y'^J�1*p Trty: Ty D. /l DENT USE ONLY Application Accepted by OMte ( Area Pit or Grout Inspection bj �D�au� //1W�1YY� (11�Fj{nalY(111r1uQpset/o1n`b�XE' Date t�,�`(� m Add4lonst CO ~14: '"' '"' �`� I Applicant - Return all coples tc•: Sar. Joaquin County Public INalth service-5 Envlro"ent■1 1loalth Dorcol t/9ervicee 4� 445 N San Joaquin, P 0 Boa 2009, Bthh. CA p5201 V FE E jAMQUNT DUE AMOUNT AEMIrT(O C�3M AEC[ryE0 1Y GATE/�- a/l'�RMIY NO. yr.. INTO ./n ol" � So t U.a V O ..u� .. .._.._ -.--• _ Q • 41 4i54 ,.r,r