SR0080264 SSNL - Laserfiche WebLink

Home Browse Search

♦a � j' ti APPLI.CATION,FOR PERMIT ii ...�..-. .v� , hVlfl SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. HAZE T ON AVE., STOCKTON, CA Telephone -(209) 466-6781 , PERMIT EXPIRES 1 YEAR FROM DATE ISSUED e (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. .� RA,It,4 407 ZC— Job Address �? 4� �' msj!�-�47 544A65 CityZ��C� Lot Size j/.� - PM _- Owner's Name ��Ld��C2. - Address --. _.._ Phone r. 'Contractor -4�01Mee_&__ Address P-1-0-e . License No-;V _S,Mac..__Phone ,8 TYPE OF WELL/PUMP: NEW WELL Ll WELL REPLACEMENT O DESTRUCTION ❑ PUMP INSTALLATION n SYSTEM REPAIR Cl - OTHER ❑ - DISTANCE TO NEAREST: SEPTIC TANK _._ SEWER LINES DISPOSAL FLD. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF.WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS A Industrial L Open Bottom til Manteca Dia. of Well Excavation Dia. of Well Casing -1 Domestic/Private C Gravel Pack O Tracy `'rr a-''•.Type of"Casm�_ _.... Specifications - \ Public ED Other 0 DeKa Depth of Grout Seal __. Type of Grout ' "i=1-Irrigation- - Approx-•Depth—Cl Eastern' Si ff6ce Seal Installed by `Repair Work Done 7 Type of Pump H.P. StafeWork bone Well Destruction Well Diameter ! Sealing Material}(top 50'1 f Fill t er MaterialBl50 (Below '1 Depth !�- - - - - TYPE OF..SEPTIC WORK: NEW INSTALLATION REPAIR/AOOI'f`ION'n DESTRUCTION U (No septic system permitfed if public sewer is available iivi[hin 200 feet.} i 1 Installation will serve: Residence f! Commercial Other iNumber of Irving units: Number of bedrooms } - 1j" C� "Character of soil to a depth of 3 feet: 4'b-0!/5 4 i Water table depth �G SEPTIC TANK C'AwTVpe/Mfg ��lf `' 1 i -&pacity__c2onP%1 No. Compartments PKG. TREATMENT PLT..❑'` � i � r � j Method of Disposal �:. \ I j fid•-- '� - T` `Distance`tb nearest: Well ; Foundationg23 Property Line ' LEACHING LINE Li ".No. & Length of lines `' ��y ` i Total length/size V41 t r _ FILTER BED L] `bistance to nearest: Well t FoundationPro jSerty;LifWf��? SEEPAGCf ITS ❑ Depth ~F Size _ 4 Number SUMPS 0 . Distancetonearest Well Foundation _ Property Line_. t DISPOSAL PONDS ❑ I hereby certify that I have prepared this application,and that the work will be one 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, I shall not employ any person in such manner as to become subject to workman's compensation law"f'61itoinia."Contractors hiring or sub-contracting signature certifies the following: "t certify that in fhe performance of the Work for which thA Oerrnit is issued, I shall employ persons subject to workman's compensa tion laws of California." II �• I The applicant must call for all eq uir -inspections. Complete d✓awino on reveVe:side. Signed X_ leo . Titr9: "h""h ` Date: 1 FOR{)EPARTINtNT USE ONLY ` Application Accepted by f't► - Date r Area O 01 Pit or Gfout Inspection by l Inspection b Date '� ' Final Addition8l Comments: I Stk 466&781 � Lodi 369-3621 Cl Manteca 823 7104 L Trar y 835-086 ; Applicant- Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 :1 tFEE ' '— "'"'•"- `"AMOUNT DUE?_ AMOUNT REMn fED-: SAS - RECEIVED Bye-- 'INFO- E— y PERMIT NO— EEm 13-24 H 13.28 1REV.r:N s i /(�' (! -d(0 ?P711