SU0002741 SSNL - Laserfiche WebLink

Home Browse Search

APPLICATION FOR PEIWIT < SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES 0 ENVIRONMENTAL UEA1,TH DIVISION r L601 E. IIAZELTON AVE. , PHONE (209)468-3420 P 0 BOX 2009, STOCKTON, CA 95201 i PERMIT E,'{PI I-L-UdR FROIi DATE ISSUED (Complete in Triplicate) Application Is hereby made.to San .Joaquin County for a permit to construct end/or instal. the work herein described. This .� application is made in compliance with San Joaquin County Ord,nanee !o. 549 and JeI and the Rules and Regulations of San Joaquin County Public Health Services. �d��A✓ E � v��,j e G City—__l— Lot 31ie/Acreage Job Address / -Q e� ✓�. n Address ....j��.}-v -,i�✓1� Phone .7tD.—/ Owner's Name .f ss-it� — �,,q� O L Phone si Co tyaclo / /�FRli syA e��f�7 deo '. �1 _�!>'�fl�!5�1 ley fn.e No. TYPE 7F WELL/PUMA. NEW WELL l., WELL REPLACEMENT i.'� DESTRUCTION L1 Out of Service well PUMP INSTALLATION C SYSTEM REP..IR Ci OTHER r Monitoring �]• DISTANCE 10 NEAREST: SEPTIC TANK ,.___ SEWER LINES r)ISPOSAL FLO.___ PROP. LINE -- FOUNDATION =AGRICULTURE :: .L OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PP -OBLLM AREA CONSTRUCTION SPECIFICATIONS ) -- - Du. of Well Czajrt0 —j C1 Industrial ❑Open Bottom G Manteca Die,cf W0 Excavation - t I Type of Casing-- I') Specdicrtions ----- •`7 Cl Domestic/Privase Cl Gravel Pack ]Tracy g Typo of Grout - I'I Public 1.1 Other El Delta Depth of Grout Sosl __ -. I I ImUmoon __Appr^x. Depth I I Eastern Surface Sail Installed by_. Repair Work Done U Type of Pump H P. State Work Done ex►ling Material a Depth Dep Well Destruction ❑ Diameter 1111er fttertal & Depth Dep lft_ - TYPE OF SEPTIC WORK: NEN INSTALLATION I 1 REPAIRrADDt TION DESTRUCTION• ' available c system st m remitted d oubl,c sawer is Installation will serve: Residence klf Comr+*,cia,-- Other Number of living units.__L-. Numberrl off�badrooms Character of soil to a 661 of 3 feet: Q - _Water table depth ` SEPTIC TANK ❑ Type/Mfg _ Cspacrty No.Compartments O Method of Disposal PKG.TREATMENT PLT.❑ 11 t l Distance to nearest: Wen � Fou-,dation_�S Property Line a! Lill i^-T—______ —T•s _- LEACHING LINE L� _No.6 Length of lines �15L Total length/si:e_ _ Property fins FILTE3 RED I 1 Distance to noaresl: Well Foundation__ SEEPAGE PITS I I Depth S,»..-_A_�r rNumber /f \ SUMPS Distance to nearest: Well Foundation J Property Line_V_siL_-- DISPOSAL PONDS C I hereby a d that the work will be done in accordance with San Joaquin county ordinances.state laws,and ilty that I neve prepared this appi,cauon see rules and regulations of the San Joaquin County Homo owner or licensed agent's signature Cemf.ts the following:"I certify that,n the performance of the work for vrlich this permit is issued,1 shall not employ any parson in such manner as to become subject to workman's compensation laws of Csl,fo:nia."Contn:tor's hiring or sub-conuactmg signature certifies Jonson.in u h ma that s the peAorm.ance of the work for which this permit is iss,iod,I shall employ persons subject to workman's compansa• tion la of alilornla." The I k t mule cell for ell rogwrod inspections Complete drawrngronreverse cede. Title: CEO,, s� Deis: Signed —�--- `L'� , R DEP R-,MENT USE ONLY w Dats Ar Application Accepted by --_ __ Das Pit or Grout Inspection by Date Final Inspection by Additional Comments: - i Applicant - Return all copies to: San Joaquin County Public Health uery ir.es, EnvironmHental Health permit/Services CA 95201 1601 E. Ratelton Ave, P 0 Box 2009, Stockton FEE AMOUNT DUE AMOUNT Rf MITTED t T RECEIVED By DATE PERMITNO. NFO — 1 fN 1I7a laEw.t/x kl 1Li C� E7 tH:a.0 .. ..��..yy T .