SITE HISTORY - Laserfiche WebLink

Home Browse Search

APPLICATION FOR PERMIT t• 1 SAN: JOAQUIN COUNTY PUBfLIC HEALTH SERVICES L EMW I g I ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 aUS3a1992 ,I P O BOX 2009, STOCKTON, CA 95201 ENVIRONMENTAL HEALTH PERMIT/SERVICES PERMIT EXPIRES 1 YEAR FROM DATE ISSUED 1>� (Complete in Triplicate) Application Is hereby arade:to Ban Jdaquin County for a permit to construct and/or install the work herein described. This application is rade in cotWliance with San Joaquin County Ordinance No. 5G9 and 1862 and the Rules and Regulations of San Joaquin County Public Health Services . Job Address 3515 Navy Drive J City Stockton Lot Size/Acreage<2MrOX 6__ac.res Owner's Name Shell Oil Compo y> Address 511 N. Brookhurst Street,A-aaheir*,one 714 'S'20`3389'` 200 Push Landing Road Contractor Harding-Lawson Asso. Address Novato, CA 949+7 License No. 537366-"", 'Phone 415)89'2=0821 TYPE OF WELL/PUMP: NEW WELL WELL REPLACEMENT ❑ DESTRUCTION ❑ Out of Service well 0 a. PUMP INSTALLATION O SYSTEM REPAIR ❑ OTHER ❑ Monitoring well _-r—DISTANCE TO NEAREST.,SEPTIC.TANK 4SEWEA,LINES DISPOSAL_FLD,. PROP. LINE approximate ^ FOUNDATION!= 'AGRICULTURE WELL POTHER WELL `�0 fit 'PITS/SUMPS T r INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS 0 Industrial 0 Open Bottom ❑ Manteca Dia. of Well Excavation 10 inches Dia. of Well Casing C.1 Domestic/Private IN Gravel Pack ❑ Tracy Type of Casing_ PVC Specifications ('I Public fl Other t, fl Delta Depth of Grout Seal Uprox. 8 ft Type of Grout CeMent-ht'_nL. I I Irrigation _Approx. Depth 1 I Eastern Surface Seal Installed by Repair Work Done 0 Type of.Pump # H.P. State Work Done Well Destruction ❑ Well Diameter "4 inches Sealing Material Depth _ - , Depth approk. 30 ft. Mller Material a Depth Clear, fine sand 8-3Q f t TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION l I DESTRUCTION I I (No septic system permitted if public sewer is available within 200 lost.) Installation will serve: Residence_ �Commercisl_ Other Number of living units: Number`of bedrooms Character of soil to a depth of 3 feet: J Water table depth ' SEPTIC TANK. ❑ Type/Mfg I Capacity No. Compartments ! PKG, TREATMENT PLT. ❑ * Method of Disposal Distance to nearest: Well Foundation Property Li LEACHING LINE Cl No. 6 Length of lines Total length/size FILTER BED D Distance to nearest: Well Foundation ProPKNY, t i SEEPAGE PITS 11 Depth �rl Size SUMPS L-I ,Distance t ., IN DISPOSAL PONDS ❑ I I hereby comity that I have prepared this applicatio that the work will be done in accordance with San Joaquin county ordinances, state laws, and F rules and regulations of the San Joaquin C •I. L Homs owner or licensed agent's signature : "I certify that in the performance of the work for which this permit is issued, I shall not [ employ any person in such manner as to �(Ubj/,w� an'a compensation laws of California." Contractor's hiring or sub contracting signature certifies the following: "1 certify that in nce o v�q for which this permit is issued, I shall employ persons subject to workman's compensa- tion Lam of California." � AA�� The applicant must call or all requir tk P. to;�ra+ring on reverse side. Signed IXP-j`'--`- tie: Senior HVdr_ogeol ogi.t Date: 2-96-1999 p CALIF DEPARTMENT USE ONLY �,!of Application Accepted by Date e aLZ Area Pit or Grout Inspection by Date Final Inspection by 4tk&!a t/ Dots Additional Comments- Applicant - Return all copies to: Ban Joaquin County Public Health Services Environmental Health Permit/Services p 445.N San Joaquin, P O Box 2009, Stkn, CA 95201 1! INFO CASH FEE AMOUNT DUE AMOUNT REMITTED CK RECEIVED BV DATE PERWlIT'NO. f . EM 14-26 I#EV,it e s, J� �• a L ! F �� 3i"P �' Eli 14-28 L/' 8