FIELD DOCUMENTS - Laserfiche WebLink

Home Browse Search

• APPLICATION FOR PERMI'* SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 1601 E. HAZELTON AVE. , PHONE (209)468-3420 P 0 BOR 2009, STOCKTON, CA 95201 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) Application is hereby made to San Joaquin County 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 and 1862 and the Rules and Regulations of San Joaquin County Public Health Services. Job Address 1050 Grantline Road City Tracy Lot Site/Acreage 14_Al Arra. Owner's Name Nark III Engineering Address 5101 Florin-Perkins Rd Sacto Phone -Q91 I Contractor Soil Exploration ServAddress P.O. Box 5993yVavaviIIPLicense No. 53969f Phone(707)451-9213 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ Out of Service Well ❑ Hydropunch PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ Monitoring Wet2 DISTANCE TO NEAREST: SEPTIC TANK NA SEWER LINES 75 ft. DISPOSAL FLO, NA— PROP. LINE 10 ft set FOUNDATION 35 ft AGRICULTURE WEL15QQ±- OTHER WELL Inn+ PITS/SUMPS -40- ft INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Air >.. Dia. of Well Casing NA P Domestic/Private ❑ Gravel Pack a Tracy Type of Casing NA Specifications NA i'l Public DCI Other HydropUnChDefta Depth of Grout Seal 10-17 ft_ Type of Grout rPmant I I Irrigation 121 Approx. Depth I 1 Eastern Surface Seal Installed by to hP inial l PcI by rontrartnr Repair Work Done ❑ Type of Pump H.P. State Work Done _ Well Destruction ❑ Well Diameter Sealing Material i Depth Depth Filler Material i Depth TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I (No septic system permitted it public sewer is available within 200 feet.) Installation will serve: Residence _ Commercial _ Other Number of living units: _ Number of bedrooms Character of soil to a depth of 3 feet: Water table depth SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE ❑ No. & Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Line SEEPAGE PITS 11 Depth Size Number SUMPS LI Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ I hereby certify that I have prepared this application and that the work will be done in accordance with San 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 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 workmen's compensation laws of California." Contractor's hiring or subcontracting 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 (call o 1 re uv ed inspections. Complete drawing on reverse side. Signed Ranee Geotech. Tide: Project Engineer Date: 1/2/92 FOR DEPARTMENT USE ONLY A !/� Application Accepted by Date Area 3(o Pit or Grout Inspection by Date /�yFinal Inspection by �� Date 176 Additional Comments: Applicant - Return all copies to: San Joaquin County Public Health / Services, Lhvlronment'sl Health Permit/Services ,-9,w �_f 1601 E. Haselton Ave., P 0 Box 2009, Stockton, CA 95201 NFO AMOUNT DUE AMOUNT REMITTED CASH RI BY DATE PERMIT NO. . EH 1}74 IREV.1INS) EH 14M