SU0013088 - Laserfiche WebLink

Home Browse Search

AP;'L!CATION FOR PERMli SAN JOAQUiN LOCAL HEALTH DIS -;ICT -7 1601 E. HALELION AVE., STJCKTON, CA PERMIT Q. elepnone (209) 466-6781 DATE ISSUED PERMIT EXPIRES 1 YEAR FROM GATE ISSUED ;Complete ir, Triplicate) Application is hereby rade to the Sar, Joaquin Local Healtr- District for a oer-nit to construct are!or install the work herein described. This application is made in compliance with San Joaquin County ordinance No. 549 for sewage or No. 1862 for well/pimp and the Rules and Regulations of the San Joaquin local Health District. Job Address 5 /Y _ Subdivision Name Owner's Name ��//Address �---7�i��1--LCL Conlractur's Name lLicense No.ZPnune -.. 1 -YPL OF_MCLL/PUMP WORD: NEW WELL � WELL REPLACEYEN- J DESTRUCTION I i I .. PUMP INSTALLATION ^ SYSTEM REPAIR 7 CTHER U ) DISTANCE iD N:AREST: SEPTIC TANK J SEWER LINES DISPOSAL FLD. _ PROP. LINE FOUNDA71ON A3Rlr-LLTL'RE WELL , OTHER I%ELL P:TS/SLA'oS INTENDED USE TYPE OF WCLL PRn31_EM AREA '-ONSTRUC110N SPECIFICATIONS Industrial Lf Cpen bottom F -j Manteca Dia. of hell. Excavation F II nonestic/Private Gravel Pack Tracy oia. of Well Casing - i] PublicOther [J Delta type of casing w E71 irrigation _ Aporox. Eastern Specifications _ (J Cathodic Protection _ Depth Depth of Grout Seal _-•. _._ _ �] Geophysical Type of Grout — _•_ U Otner Surface Seal Installed by _ Z Repair Work Jane F-1 lype of Pump _ _ H.P. State Work Done t well Destruction ❑ well Diameter Sealir-g Material (top 501)- Cept''t _ Filler Material (Below 50') _ _ ./ TY?E OF SLP'.IC WORK: NEW INSTALLATION LI P,EPA:R!ADDITION [_j (No septic tank or seepage pit permitted if public sewer is available within 20O feet.) Installation will serve: Residence 1/11" commercial _ Other Nunber of living units: Number of bedrooris Lot size Character of soil to a __/ depth of 3 feet: .QQ-?^�r�,�r, _ _ Water table depth - / �l SEPTIC TANK � Capacity D No. Compartments Type/Mfg �/r✓A --� i% = -J � ' PKG. TREATMENT PLT. U Type/Mfg _ Capacity Method of Disposal SEWAGE SYSTEM _.^ Distance to nedrest: dell 6p Foundation Property Line DESTRJCTICN--- / , LEACHING LINE L� /� yy Total length/size No. 8 Length of lines � � H-c�/�-� — - — FILTER BED [_1 Distance. to nearest: Well Foundation _�oroperty (toe SEEPAGE PIIS r l Depth _ Size Number — SUMPS U Distance to nearest: Well _ Foundation _ Property Line DISPOSAL PONDS C� I hereby certify that i have prepared t'nis application and that the work will he done in accordance with San Joaquir. county ordinances, state laws, and rules and regulations of the San .'oaquin Local Health District. Home omivr or licensed ayent's signature certifies the .following: ": certify that in the performance of the work for whic5• this permit is issued, I shall not employ any persor in such manner as to become subject Lu workman compensation laws of California." Contractor's hiring or sub-cor'.tracting siSildture certifies .he following: "I rert``y that in the performance of the work for which this permit is issued, I shali employ persons subject to workman's compensation laws of California." The applicant nsl call for all r fired inspections. Complete drawing on reverse side. 9 r��%_.✓,��''� _ Title: Date: elp -7�� - Si nee )< -- - �R�EP/tTTMENT USE ONLY f Stk 466-6781 Application Accepted by �_. Area _fL.l � ) Additional Co-ments: __ Lodi 369-3621 Pit or Grout Inspection by _ Date '+anteca 823-1104 Final inspection by � _ Cate ��—�/ /�1l(t� Tracy &35-6385 Applicant - 'Return all copies -to: Environmental He .th ?emit/Services 1601 E. Hazelton. ,v P.O. Box 2009, Stk., CA 9520! -�.-_ I PERV17 N0. FEF I DASC AMOUNT DUE AMOUNT REMITTED R=CLhVEp 3Y DA,'F —J Lal -Az -73 `- 11.11152 5C0 EH 13-24 REV. 10182 14-26