FIELD DOCUMENTS - Laserfiche WebLink

Home Browse Search

" SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES s ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 P 0 BOX 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 20500 Holly Drive City Tracy Lot size/Acreage 1100 acres Owner's Name Holly Sugar Corp. Address P.O. Box 60, Tracy CA 95378 Phone 209 835-3210 Contractor Environmental Expl: IrA d6ess496N. TaTEhip Rd., Yaks CitYLicense No.582205 Phone 916 755-3745 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT n DESTRUCTION O Out of Service Well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER O Monitoring Well DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES CRS' 50 ft' DISPOSAL FLD. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS 0 Industrial O Open Bottom O Manteca Dia. of Well Excavation in. Dia. of Well Casing 411 Cl Domestic/Private 0 Gravel Pack O Tracy Type of Casing Fy� Specifications I'1 Public Cl Other F1 Delta Depth of Grout Seal 10 ft Type of Grout dLdI I Irrigation 254 Approx. Depth I I Eastern Surface Seal Installed by 11 i �'� Repair Work Done U Type of Pump H.P. State Work Done _ Well Destruction ❑ Well Diameter Sealing Material i Depth Depth Filler Material 4 Depth YPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I 1 DESTRUCTION I I (No septic system permitted if 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 O Type/Mfg Capacity No. Compartments �{ PKG. TREATMENT PLT.❑ Method of Disposal u Distance to nearest: Well Foundation Property Line LEACHING LINE O No. b 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 ❑ 1 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, 1 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 compensa- tion laws of California." The applicant mut call for all jr�equir i specti . Complete drawing on reverse side. - - Signed=� /"t s Title: _C/EO�O�i57 /r ��tf�iO ��r�O Date: �C .�C Q� �./'� n A FOR DEPARTMENT USE ONLY Application Accepted by 0_q Data V Z,. Area (y✓`1 r Date r/I 0Z Final Inspection by Date Pit or Grout Inspection by 1Tt 1� Additional Comments: &' 'L Applicant - Return all copies to: San Joaquin County Public Health Services Environmental Health Permit/Services q Q (r 445 N San Joaquin, P O Box 2009, Stkn, CA 95201 n FEE AMOUNT OUE AMOUNT REMITTED CK RECEIVED BY DATE PERMIT NO. INFO // /� CASH r EH 4174 IRtY. /.151 $'-] `�I � �J`� 1 EH 14.711 ( ((