SITE HISTORY - Laserfiche WebLink

Home Browse Search

SANtJOAQUIN COUNTY PUBLIC HEALTH SERVICES W � eo (fir b aa-h cr?s ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 tho �^ [` 1 P O BOX 2009 .,STOCXTON, CA 95201 Z M �q '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. k mirk brtrl1 dont_-{cr i*K fiYralf 3ik l Grkd Gt}: Job Address '3515 1+JAV D>-IIlr i City 5fiix-rf��l Lot Size/Acreage Snjlly�✓Il F4hl'111 �(7'7at �. !"Aar7w h G�CttTi,'r Phone Owner's Name �� Address { II Contractor �Ct�lu`6[ha'I Address mµ1 fL;j U 1 d r IZQnc110Z --_—License No. Phone TYPE OF WELL/PUMPS NEW WELL ❑ WELL REPLACEMENT Ll_ DESTRUCTION ❑ out of Service Well. G1 Win,,oring Well PUMP INSTALLATION C?_ SYSTEM REPAIR ❑j OTHER $f Oe,M"lN` s ❑ DISTANCE TO NEAREST: SEPTIC TANK A- -SEWER LINES 'DISPOSAL FLD. PROP. LINE FOUNDATION {�tjvVl L1�C AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL' PROBLEM AREA CONSTRUCTION SPECIFICATIONS Ll Industrial ❑ Open Bottom ❑ Manteca Dia.-of Well Excavation 2 Dia. of Well Casing r 1 k El Domestic/Private 0 Gravel Pack ,J 0 Tracy, .. _4� Type of Casing_ 1Jk Specifications N~ .I 11 Public 1:7 Other 171 Delta Depth of Grout Seal' w Type of Grout I i Irrigation —Approx. Depth I I Eastern' Surface Said Installed by Repair Work Done 0 Type of Pump H.P. State Work Done Well Destruction O Well Diameter Sealing Materiai & epth p De th j�I f Iler eria.l & pth J_ TYPE OF SEPTIC WORK: NEW INSTALLATION I I- REP(AIRA DDITION { I DES RUCTION I I (No septic system permitted if public sewer is II available within 200 feet.) Installation will serve: Residence Commercial— ther 1 - Number of living units: Number of bedrooms Character of soil to a depth of 3 feet: rf Water table depth r1 SEPTIC TANK 0 Type/Mfg 1 Capa ity No. Compartments PKG. TREATMENT PLT. 0 `# Method of Disposal. Distance to nearest: Well �Fdtic Property Line 1/ LEACHING LINE L1 No. & Length of lines Total length/size FILTER BED ❑ Distance to nearest: We Foundati Property Line 4 SEEPAGE PITS I l Depth Siva Number SUMPS Ll Distance to nearest: Well Foun n Property Line DISPOSAL PONDS 0. I hereby certify that I have prepared this application and that the work will be done in a cordance 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 pe rmance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to workman's compensation laws f 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 is ued, i shall employ persons subject to workman's compensa- tion laws of California." The applicant call for all required inspections.'Complete drawing on r v se side. ��— ¢• --,-- � . Signed X, Title: � Date: AFOR DEPARTMENT USE.ONLY,„Date L Area��Rtw- ' i G Application Accepted by — Pit or Grout Inspection by Date Final Inspection by' Date Additional Comments: Applicant - Re n all copies to: San Joaquin ounty Public Health Services -Environmental Health .Permit/Servicesr 445 N. San Joaquin, P O Box 2009, Stkn, GA 95201 CSI l FEE AMOUNT DUE AMOUNT REMITTED CK 0 ASH RECEIVED BY OAT PERMIT'NO. INFO . EH1 3.24IREv.11K51 : 60 t Do '975- EH 1420