Laserfiche WebLink
SA,N JOAQU:N COUNTY PUBLIC FEALTH SZRCICES _ <br /> F-h''IRON-4:ICTAL HEALTH DIVISION 00 [P <br /> 445 NSAN JOAQUIN , PHONE (209)468-3420 <br /> P 0 BOX 2009, STOCKTON, CA 95201 <br /> PERb9IT EXPIFES 1 YEAR FROM DATE ISSUED <br /> (Com;1e,.e In T_lpllcaze) <br /> Application Is'he-eby made to Sam JoaQuin County 'o- a pe-=It to conatruct and/er ,net&= the vo-x herein cert-_bed l"_s <br /> application is made int catpliance vith Sam Joaquin Count,, 0-dinance No 5L9 and 1862 and the P"es and Re6ulatione Of San <br /> Joaquin County Public health Scryices <br /> Job Address 5 City �] L., Size/Ac-case d-Q q <br /> Owners Narre Rm4oiodress � 1� ��"' nd < �171t _ PhonZ5-IO • �� /`�� <br /> V 1 L N.4 LC G7 <br /> Contractor Address Cr q �Crne + 'f No 4-/L5"2-:7>20 Precnr-A S . <br /> TYPE OF WELL/PUMP NEW WEL WELL REPLACEMENT -7 DESTRUCTION 0 C><.t Of Service Well ❑ <br /> PUMP INSTALLATION 0 SYSTEM REPAIR - OTHER C Moritorin5 Nell C <br /> DISTANCE TO NEAREST SEPTIC TANK SEWER LINES DISPOSAL FLO PRO° LiNE <br /> FOUNDATION AGRICULTURE WELL OTrIER WELL PITS/SUMPS <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS <br /> Industrial C Open Bottom C Manteca Ota of Well Excavation Dia of Well Casing <br /> 1Z17omestic/Private LI Grave; Pack 0 Tracy Tope of Casing_ �� G Soecifrcallons <br /> I Public ><Zther ill Delta Depth of Grout Seal�� Type of Grout - <br /> I I Irngalion _ Approx Depth I 1 Eastern Surface Sail Installed by 11e-1I <br /> Repair Work Dane U Type of Pump H P State Work Done <br /> Well Destruction O Well Diameter Sealing Material L Deptb <br /> Depth Filler trate-1al L Depth <br /> TYPE OF SEPTIC WORK NEW INSTALLATION I I REPAIR/ADMTION , ! DESTRUCTION I , INc septic system permitted of ptiblic sewer is <br /> available within 200 fee; I <br /> lintion will serve Residence — Commercial_,_,^ Other <br /> umber of living units Number of bedrooms <br /> Character of Boll to a depth of 3 feet Water table dep,h <br /> SEPTIC TANK 0 Type/M1g Capacitt No Compartmentsi <br /> c �'s�e <br /> ll <br /> 1 . t r i <br /> PKG TREATMENT PLT L7 Method of Disnosal _ <br /> Distance to nearest well Foundation Property Line } '= c" <br /> _ D D� <br /> LEACHING LINE D No b Length of lines Total length/st:e C"i <br /> FILTER BED ❑ Dis ante to nearest Well Foundation Property Line aU-3'-i" l-IIAL T; <br /> SEEPAGE PITS i I Depth Sire Number <br /> SUMPS LI Distance to nearest Well Foundaucin Property Line <br /> DISPOSAL PONDS 1 <br /> 1 hareby comity that I have praDar&c this application and tna the work will be clone in accordance with San Joaauin county ordinances state taws and <br /> rules and rogulations of The San Joaquin Cotx%-e <br /> home owner or licensed &gen'a s+pn&ture ceri&ot the following I certify that in the performance of the work for which this permit is issued 1 shall hot <br /> employ any person in such manna as to become submit to workman s compensation laws Of Cildornia Contractor s hiring or subcontracting argna,ufe <br /> Certifies the IohDwthV I Csnity That in the performance of the worn for which this bo•mit is issued I shall smoloy Pe=nt subject to workman s com;>an a <br /> lion laws of California <br /> The applicant T tail for all raflwreC inspect ons Compiele Drawing on reverse &toe <br /> � 7" <br /> SIg^e� :lcr� �r`.�l�=C.'...� Title / --,�..���C /c / Data p <br /> �Y} �Y OR DEPARTMENT JSE ONLY <br /> AppSicatton Acceptee by , Il �� 1 Dale . _L� Area <br /> Di or Grow Inspection by Date F nal Inspection by Date <br /> *nal Comments <br /> pplicart - Retu-r Ell eepies to Sar Joaq%.in County Public Health Se-,ices <br /> Eatironmental }iealtc Pe-fait;Ser%ices <br /> 445 h S412 Joagc,ir, P 0 &ox 2004 Stf•rt, GA 85201FIE <br /> INFO AMODUN- DUE AMOUNT REM,'TED -C,S,, I RECEIVED Fy � �j DATE <br /> 11 PEERM- Nch <br /> I� fK 1:0a IAEv Ii--,i F �� �� D��� ��4P� I �� ! l ✓ i <br /> En it <br />