WP0040151 - Laserfiche WebLink

Home Browse Search

102-� .ter �i.1 P"% , APPLICATION (��aD��-- a C3 V 4 -63' - . GS-�QrS" SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES EN V I RONIAENTAL HEALTH DI IDQ-1 9 445 N SAN JOAQUIN, PHONE (20 )08-Zia— Job tact j8b- P 0 BOX 2009, STOCKTON, 9520p ES 1 Y S(Complete i❑ Triplic )i1 . ftFI:,:Application is hereby II"e,to San Joaquin County for a permit to construct a d/or inotapplication is sine in 'eo®pllanee frith San Joaquin County Ordinance Ho. 549 ndlllf�FZ alona of $Joaquin County Public Health Services. 1i t1 JJ iAddress 12920 BYROM HWY City TRAACY Owner's Name ANNE G. STELLE Address 12920 BYRON HWY , TRACY-,CA Phone 835-7276 Contractor HENNINGS BROS. DRILL,Addressaa?5 PELANDALE,MOD 95356License No.290813 Phone 545-11 R5 TYPE OF WELL/PUMP: NEW WELL O WELL REPLACEMENT DESTRUCTION C)( Out of Service Well 0 PUMP INSTALLATION 0 SYSTEM REPAIR O OTHER 0 Monitoring Well 0 DISTANCE TO NEAREST: SEPTIC TANK 140 '+ SEWER LINES 1 40 1-4- DISPOSAL FLD. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS .� INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS 0 Industrial 0 Open Bottom Q Manteca Dia. of Well Excavation Dia. of Well Casing 11 CX Domestic/Private Gravel Pack X3 Tracy Type of Casing_P V C 5pecificationsl 6 OSr h I Public Cl Other n Delta Depth of Grout Seal 0O 1 Type of Grout BentOflltP_ I I Irrivalion Approx. Depth I I Eastern Surface Seal Insialied by H E N N I N G S B RO S. DRILLING CO. Repair Work Done U Type of Pump H.P. Stats Work Dona_ Well Destruction )(:X ( Well Diameter 6 r` Sealing Material i Depth S _P P TT IIQ Depth 50-60 1 A Nr n x. Filler Material i Depth TYPE OF SEPTIC WORK: NEW INSTALLATION I i REPAIR/ADDITION I I DESTRUCTION I I lNo septic system permitted if public sewer is available within ZOO fest.l Installation will serve: Residence— Commercial_ Other Number of living units: Number of bedrooms Character of sail to a depth of 3 feet: Water table depth SEPTIC TANK O Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT, O Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE 0 No. & Length of lines Total length/size FILTER BED O Distance to nearest: Well Foundation Property Line SEEPAGE PITS I I Depth Sin Number SUMPS LI Distance to nearest: Well Foundation Property Lima DISPOSAL PONOS 0 I hereby certify that I have prepared this application and that the work will be done in accordance wiLh S#n Joaquin county ordinances, state laws, and rules and regulations of the San Joaquin County Home owner or licensed agent's signature certifies the following: "I cenily that in the performance of"the work for which this permit is issued, I shall not arnploy any person in such manner as to become subject to workman's corr"nsalion laws of California." Contractor's hiring or subcontracting signature Upnlfies the following:'9 certify that in the performance of the work for which this permit is issued,I shall employ persons subject to workman's eompensa• tion laws of Califomia." The applicant must all for all required inspections. Complalle drawing on reverse side, Signed Data: OCT. 8, 1993 FOR DEPARTIMENT USE ONLY f Application Accepted by 1 Data b Area Pit or Grout Inspection by Date Final Inspection by Date 1 Additional Commence: Applicant - Return a 1 copies to: San Joa uin County Public Health Services Environmental Health Permit/Services 445 N San Joaquin, P O Sox 2009, Stko, 201 ��1�8 i Q] FEE AMOUNT DUE AMOUNT REMITTED C H RECEIVED BY D TE PERMIT-NO, INFO 1A.7- s.�i,:rr ri•sr „v s� / - ! '% o?��” /7 X113 93