WORK PLANS - Laserfiche WebLink

Home Browse Search

APPLICATION FOR PERMIT SAN JOAQUIN LOCAV14FALTH DISTRICT 1601 E. HAZELTON AVE.'. STOCKTON, CA etl 't Telephone�12091 •46Cr&78110 of t,10"n 0"0' 1'a 1�9d} tL�9n ItuU PERMIT EXPIRES 1 YEAR FROM DIATEI7SS'JEDihr; J�o�l 1�ohy lrr n marl .e '.oICompletd 1n TriPlicawl z lr.•N n.- z,/5 ,,:II) .� app6carion rt to construct and/or instal die work heron descT�ed��San Josgt�n joaouin Health District for a or No.1062 for wen/pump and the Rulera'ard Ragu!315 n the O 1 IpDlication is hereby made to the um County 0 dnance No.549 for saw a0a p. RC to IIC):PIl•;O ca i' I 0 node in comdiancewith San JOaq -,,.� WIG T:: ,:::,�•a �n 7•.1::1': R � level Health Disbkt'-"u'!EI•.. , •'t,np s•ara.'•-:" - i rte?; :-. +n ?Ilit:i-• lild- !:11^.•'.v "19�to� �no...; . tin .� .'il"v .v.: /q ,•tt nr c,.Ilicb^•'K,O�.L) : t`tPM'^ 1 JobAddreas _. ..._.. . _ ._.. _ ZZpI W W gs G -Address .. - _ .1 t� ra ZA Concood License NO.'�StO Fhona { Address Contracts KU11�'1 u.a9 DESTRUCTION ❑ - r NEW WELL ❑ WELL REPLACEMENT ❑ ._ OTHER f31 �I�ZJx+v� TYPE OF WELLI PUMP: YSTEM REPAIR ❑ _ 1 PUMP INSTALLATION ❑ DISPOSAL FLd. PROP. LINE -:•r 1• SEWER LINES �— :PITSlSUMPS _- DISTANCE TO NEAREST: SEPTIC TANK AGRICULTURE WELL OTHER WELL -- - - - .I FOUNDATION I 1/411 1 INTENS USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS' .Db of W�CasinO l Dia. of Well Excavation i Q Industrial ❑ Open [I Manteca VL Spodficatiom -- ❑Tracy .-Type of Casing kt+- 8 Type d Gran p Domestic/Pr vete ❑ Gravel Peck, ❑ Delta Depth of Grout Seal A I _ 0Public !tZ Other I i Surface Seal Instilled W-�� 0 Irrigation �Approx. Depth ❑ Eastern State Work Dam nI Repair Work Done C3 Type of Pumpone H.P. . _ • • _i_ L Well Diameter Sealing Material (top 50.) Well Destruction ❑ - Filler Materiel (Below 50') Depth_� if public sewer a • available within 200 feet) ! 1 ! ,T,YPE OF SEPTIC WORK:; NEW INSTALLATION ❑ REPAIR/ADDITI,ON ❑ DESTRUCTION L7 (No Septic system 4 ;- Ccmmercial_ !Other Installation will serve: Residence_ , S_ ._LT- - -•--t"' Number of living units: Number of bedrooms ,. _Vileter table depth s Character of soil to a depth of 3 teat: Capacity No.Cpmparmlanca .. _: - SEPTIC TANK ❑ TYPO/Mfg I - � Method of Disposal Property fang y I PKG.TREATMENT PLT.❑ " ' i !Foundation - Distance to nearest: I Well ' ! total length/sine '`: ❑ No. & Length of lines! - l LEACHING LINE Foundation I I Property Line I -_ FILTER BED V ❑ Distance to nearest: well , l I --_-_�-.-j,_-�""_ . 1 h Size iNumber ❑ Dept __ 1-1 -- SEEPAGE PITS Foundationf Property LiM j SUMPS 1 ❑ Distance to nearest: Well DISPOSAL PONDS ❑ _ -�-' application and that the work will be done in accordance San Joegluin county ordinarn�_ state�, er I hereby certify that I have prepared this epD , rules and regulations of the San Joaquin Local Health District. performance of the work for which this permit b issued• I shall rwt Homeowner or licensed agent's signature certifies the ct to following: "I certify that in the Pa 1 well Contr persons wbract to v orxrnan s cor?+pe^!°�• employ any person in-such nla^nor as to become subject to workmen's compensation awe of California."Cohtrecto(a hiring or wlrconlra:tin0 signettrra g:' nl , Certifies the followin •1 certify that in the perfortnence of the work for which this permit is issued, - l ; ,,on laws of California:' i - _ I �--�- +- I-'*-'-?--The applicant must call for all r ed inspecthos. Co Plato drawing on / " . � �Do / _I Z/ �� Title: Signed PA{iTP UE O SNLY ! ` _ _ _ ��1•• j �IAt tea .� pate. Application Accepted by ection by, Pit or Grout Inspecti iDate Final Insp , 1, M � �-�, Additional Comments: r ❑ Mentace 02&7761. racy..835 fii8G� i ❑ Stk 46fi-601 C1 Lodi 369- i Eng-312 ental Health Pemvt/Servlcea 1!01 E. Hnzalton Ave;. P.O. Box 20C9•_S.tkyCA.9!1.01_ .... It Appicant• Return ell copies I CKs PERMIT NO. . AMOUNT REMITTED CA.: RKENED 6Y I bATE FEE AMOUNT DUE ,.___1--1 e- .� ' l �. ` INFU p.