FIELD DOCUMENTS - Laserfiche WebLink

Home Browse Search

APPLYPAT N FOR S JOAQUIN COUNTY PUBLIC HEALT�ERVICES 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 Ban 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 Ban Joaquin County Public Health Services. Job Address 1050 r.-antline Road City Tragi Lot Size/Acreage 14.41 Acres _ Mark III Engineering Address 5101 Florin—Perkins Rd, Sacto phone (916)451-9 Owner's Name 213 Services21 Contractor Soil Exploration Address P.O. Box 5993, Vaeavilk�ense No. 582696 Phone(707)451-9 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION Ll Out or 8ervlce Well ❑ (Hydropunch) PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ Monitoring Mrli DISTANCE TO NEAREST: SEPTIC TANK NA SEWER LINES 75 ft DISPOSAL FLD. NA PROP. LINE 10 ft (feet) FOUNDATION 45 ft AGRICULTURE WELL 500+ OTHER WELL 700+ PITS/SUMPS 25 ft INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS fl Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation max Die. of Well Casing NA Bd eenrestic/Private Cl Gravel Pack tH Tracy Type of Casing NA Specifications NA I Public ISA Other Hydropunab Delta Depth of Grout Seal 12-15 ft Type of Grout cement \ I I Irrigation Ili! Approx. Depth I I Eastern Surface Seal Installed by t0 be installed by Contractor Repair Work Done ❑ Type of Pump H.P. State Work Done _ Well Destruction ❑ Well Diameter Sealing Material A Depth Depth Filler Material i Depth TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I INo 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. B Length of lines Total length/size 1 FILTER BED ❑ Distance to nearest: Well Foundation Property Line SEEPAGE PITS 11 Depth Size Number - V 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 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 compensate tion laws of California." The applicant pt stcal fall a uired Inspections. Complete Coommpllettee drawing on reverse side. Signed �" Title: L Date: � FO DEPARTMENT USE ONLY Application Accepted by Area Pit or Grout Inspection by a Final Inspeeltioonn by Date Additional Comments: -- Applicant - Return all copies to: San Joaquin County Public Health Services, Environmental Health Permit/Services 1601 E. Haselton Ave., P 0 Box 2009, Stockton, CA 95201 n FEE "AMOUNTD CKRECEI D BV DATE PERMIINFO CASHEH 13flIREV.i/nlly' S o3 ��-�� 74.,ml EH IF 26 i r