SU0010713 - Laserfiche WebLink

Home Browse Search

lv �_u2 u —3 U APPLICATION FOR PERMIT A t art La Ia/ oZ Z SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. HAZELTON 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. !a NSI a f- Job Address ^ _ �p s7 T / „ (``� City 4 `H-� dl Size - PM Owner's Name !- 00 Phone o Contractor Address f License No. 'hc .Tda C TYPE OF-WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ ' PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ DISTANCE`TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE I I FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS t INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECT ICATIONS� O Industrial ' ❑ Open Bottom ❑ Manteca Dia. of Wen Excavation I / Dia. of Well Casing _ v ❑ Domestic/Private i ❑ Gravel Paci ❑ Tracy J J `TMn of Casing -•�. �'-` Specifications 1 !hCo�G - rr • ❑ Public I ❑ Other.�� k..� ❑ De Delta.r.�.., ' ' pt rdut Seal '" �}} \� ..^ Type of Grout ❑ Irrigation ; --Approx. Depth O,Esswom W-Surface-Seal-tnstalled4aµ'��'^- ---�__ Repae Work Done +❑ Type of Pump ' ..e/ H.P. _ t��WOrk Done. Welruction !❑ Well Diameter Searing Material (top 50'1 { f4 Depth Filler Material (e low 50'1 � TYPE•OF SEPTIC WORK: NEW INSTALLATION ❑ REPAIR/ADDITION DESTRUC UN'❑ (No septic system permitted if pudic sewer is - available within 20o feet.l - Installation will serve: ReldenceCommercial_ her _.,,_____�---.� /i. Number lof living units: Num r of bed ` { . �- Character of soil-Lo a, et: depth of 3 fe - k , Wat\er table depth 2,-v _. SEPTIC TANK ;❑ Type/Mfg Capacity No Compartments _ P)CG.JRFATMENT PLT. ❑ M hod of Disposal rr `' Distance to nearest: Well Foundation Property One I r LEACHINdUNE r No. & Length of lines r total loor sae r ��D4 FILER BED � ❑ Distance to nearest: Well L� Foundation % Property Line SEE✓PAGE PITS la--Der epth �.5� Size— 3 Numb � espr-Ill �. SUMPS? ( � ❑ Distance to nearest: Well C� Foundation Property Line� �`` y� rSPOSAL PONDS ". ❑ -�Ia=t� t \) -I hereby certify that have prepared this application and that the work will be done in accordance with San Joaquin county ordinances, state laws, and ales ) and regulations,of the San Joaquin Local Health District. Home owner cr licensed agent's signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ arl person in'such manner as to become subject to workman's compensation laws of California."Contractor's 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 California:" The applicant must call for all required inspections. Complete drawing on`reverse side. Signed X Title: ` Date: �- FOR „J \R DEPARTMENN T USEONLY.-�+y Application Accepted by Data...1,2- Area d Z Pit or Grout Inspection Data I?--/1A Final Inspection by Data Additional Comments: U Stk 466-6781 ❑ Lodi 369-3621 Fl Manteca 823-7104 ❑ Tracy 835-6385 r Applicant- Return all copies to: Environmental Health Permit/Services 1801 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 FEE AMOUNTDUE AMOUNT REMITTED RECEIVED BY DATE PERMIT NO. INFO C