FIELD DOCUMENTS - Laserfiche WebLink

Home Browse Search

V APPLICATION FOR PERMIT � SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION P O BOX 2009, STOCKTON, CA 95201 (209) 468-3447 pEgUIT EXPIRES 1 YEAR ?RON DATE ISSUED (Complete in Triplicate) Application is hereby made,to San Joaquin County for a permit to construct and/or install the vork 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 450 E. Grantline Road City Tracy Lot Size/Acreage 10 acres 913 Owner's Name Doane Products Com anyddress 450 E. Grantline Road Phone(209) 835—$IZZ Contractor S ectrun Ex loratiQd-,>e5S 2825 E. Myrtle, StOGC tnse N0.512268 Phone(209) 465-8712 TYPE OF WELLIPUMP: NEW WELL ❑ WELL REPLACEMENT 0 DESTRUCTION ❑ out of Service Well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ Monitoring Well DISTANCE TO NEAREST: SEPTIC TANK 251 SEWER LINES 51 DISPOSAL FLO. N A PROP. LINE200 t e500 � FOUNDATION 51 AGRICULTURE WELL 1 r,llE THER WELL PITS/SUMPS N/A INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS n Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation inch Dia. of Well Casing 4 inch U Domestic/Private (N Gravel Pack =racy Type of Casing PVC Specifications SCh 40 M Public 1'1 Other ❑ Delta Depth of Grout Seal 5 t Type of GrouQement/$ent 0 Ir6oauon Approx. Depth ❑ Eastern Surface Seal Installed by Water Repair Work Done U Type of Pump H.P. State Work Done _ Well Destruction ❑ Well Diameter Sealing Material & Depth Depth Piller Material & Depth TYPE OF SEPTIC WORK: NEW INSTALLATION❑ REPAIR/ADDITION M DESTRUCTION G (No septic system permitted it public sewer is available within 200 feet,l 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 n Distance to nearest. Well Foundation Property Line / SEEPAGE PITS I 1 Depth Sire 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 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, l shall employ persons subject to workman's compensa- tion laws of Californlo." The applicant must all for all re irad inspections. Complete drawing on reverse side. Signed Title: Groff} Qr s:�. �1� .�. Date: FOR DEPARTMENT USE ONLY Application Accepted by Date_,G/ 2 [ 0 Area �3 fILOT Pit or Grout Inspection by (f am u` '�� Date? Z-7 G Final Inspection by l�* � Date��2 Additional Comments: Y r Applicant - Return all copies to: SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION PERMIT/SERVICES 445 N SAN JOAQUIN, P O BOX 2009, STOCKTON, CA 95201 FEE K i INFO AMOUNT DUE AMOUNT REMITTED CASH RECEIVED BY DATE PERMIT NO. . EH 13-24 MEv.,r F1 5, (�v} Co C� 1,Q'al 'Q_ I J EN;<•?e