ARCHIVED REPORTS_XR0011599 - Laserfiche WebLink

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r++ 00-11-1993 08:35AM FROM TO 15102951823 P.e2 APPLICATION SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES 'l :; ENVIRONIdENTAL aF4LTH DIVISION 445 N SAN J'OAQU IN, PHONE (209)468-3420 P O BOX 2000, STOCKTON, CA 95241 ' PZAMI EXEIRES I YEAR FROM DATE IS91UND (Complete in Triplicate) Applicatiem it hereby made to San Joaquin County for a permit co constmot kn$/or insta`n the vork herein describad. This application to made in cwwliance rxth inn Je64uin County Ordinance No. 549 and 3862 and the Ru1ee and Angulations or San _ 3oarquin County Public HAaith 6e"Ices. }}-- `` � /�� Job Address J a a awT� ry 4.l___Lxl�' City te Lot Siac/Acrdage J"00 So t t�AA rty 4')27 Phon y � Ownar's Nam» ,9P ,0t;/ G.%#"" Addres9 ,i lokwi a LY/ 4a d50;/_1 F?�*'69r'ri�n fv dGreSs P.Q.A)ax OW-3WWVl## Contractor tMe se Mo `J —ift4114bone , 7 TYPE OF WELL/PUMP; NEW WELL ❑ WELL REPLACEMENT F1 DESTRUCTION 0 *ut or ervlee Nell PUMP INSTALLATION 0 SYSTEM REPAJR Cl THER ❑ Noaitoring well D1StANCE TO NEAREST: SEPTIC TANK SEWER LINES ?5_27 DISPOSAL FLD PROP. LINE - FOUWELL NDATION r AGRICULTURE OTHER WELL-5—O' PITS/SUMPS ATA !' IIYTENpED USC TYPE OF WELL PROBLEM AREA CONSTRUCT{ON SPECIFICATIONS yr 'I Ll Industrial ❑ Open Bottom L� Manteca Die. of Wolf E>fceyadan.� Dia. of We" Gating Z n Domesric/Private ❑ Gravel Pack O Tracy Type of Casing_ Specification VI Public 1- Other F) Delta Depth of Grout Seal Type of Graul F '� L I Irridi[ion �Approx. Depth I I Eastern Sarfaee Soul installed bV —— - Repair Work Done 0 Type of Pump H.P. State Work Done T, Well Destruction ❑ Well Diameter Sealing Material A Depth I E". Depth Filler Material i Depthe"'d TYPE OF SEPTIC WORK; NEW INSTALLATION I I HEPAIRlAo0i'n 7N i I DESTRUCTION I I (No seplic aystem permilled it public saWer is available within 200 feet.) InSI&IIation will serve: Aesidence_ Commercial Other `i Number of living units: Number of bedrooms - Character of sof!to a depth of 3 loot;__ _— - Water table depth SEPTIC TANK- O Type/Mfg Capacity - No. Companrr►anp PKQ. TREATMENT PLT.❑ Method of MsposM xi Distance to neareal; Well Foundation - Property Line 7F*Ylft■'� .i ,�I LEACHING LINE a No, l4 Length of lines ___—__ Total length/size FILTER BIEb n Distance to nearest. Well Foundstion _ Prgperty Line,94-13_ 3 SIN 1171� plffl COUNTY SEEPAGE PITS I I Depth _Size Number SUMPS LJ Oisfance to nearest Wall Foundation._ PrOlp"ft"ME ITAi WEALTH DIVISION DISPOSAL PONDS O I hereby certify that I have prepared this application and that aha work will be done In accardanQe with San Joaquin county ordinances, state low%, and rules and regulations of the San Joaquin County (;s Henan owner or licensed agent's iagnetwo certifies the following: "I pgrtily that in the performance of the work for which this permit is Issued, I sh4H not arnploy any parson in Such/hannor as to become subject to workrnon's compensation laws of California." Contractor's hiring or sun-cgmrsctir+g signature n/-y eartlflaa the TtNlowirtg:"I certity that in the pdr4orrnllme of the wor4 for which this permit is issued,I shall employ persons subject to workman's corhponsa- I..r tion laws of California." r1 The applicant rnuge f�ailulr.#dInspections. Complete drawing an reverse,side, 01 Signed X __ —� Title' � Doto,; � `+ FOR 13EPARtM1:NT 118E ONLY - 'Appgeation Accepted by Pato Area S Pit or 13rour Inspection by __. Data Fina( Inspection by Date Additlonal Corn"Nals. lt-r b �� 7 Applicant - Return all CoDiew to: San J04-Quin County public Heal%h Services21 Saviroamental Health ,permit/Services 445 N San Joaquin, P D Boa 2009, Stkn, CA 95201. 1 4/•tLl INFO AMOUNT Mli AMOUNT REMFTTED rCf$ AECEIVfb By ASH . P 0A7E ,�ynS�Jy +��c7-►H lw.� /f I/ �7 lERM(T So. rtJ -r .Y 19-II IREV.iln Sr X1"1 r ?rr�r /Pcf �- ! / e .:,ll H•zd rIi TOTAL P.02 L'