Laserfiche WebLink
RECEIVED <br /> SAN JOA•IN COUNTY PUBLIC <br /> HEAL= SEOCES <br /> SEP 181991 SNVIRONVENTAL HEALTH DIVISION <br /> 4ASNS$xJOAQO91NSTOCKTON, CANE 95201PO <br /> ENVIRONMENTAL AUDIT <br /> pFnt�IT F.%PIRBS 1 YEAR FROM D9TE I <br /> (Complete In Triplicate) <br /> rA in <br /> vo <br /> Ayplieauoo is hereby rade to San Joa:uin County 'cc a prrrlt to cooatrutyoaG ond 16o27nd heeRu:les hand efteg.'letl onee: <br /> ayyiimt:on Sa mae in c .•y::nn<e vi t1+ can Jon4u:n Ccnty Ot•dineaee No. 5 <br /> Joequin County Public RealL 1 9ervieee. Stockton v <br /> 5400 Pacific Avenue City <br /> lAt SxeiAcrea6e <br /> Jct:Address Q li West <br /> j 5400 Pacific Avenue Phone (415) x/94-2277 <br /> Owner'a Namo <br /> Mont omerlo' Ward Address <br /> Auto SerYice Center L+cause No. Php"° —' J <br /> Fddr!ss__.. <br /> Corasctor Ad AUaBY WELL REFLACEM£NT I I DESTP.UCTtCN a u: at Serv:cs <br /> Ty� NE:V WELL ❑ OTHER G Hcriur'v Vet= Q <br /> P.'MP INSTALLATION C' S•i5T£a/, REPAIR <br /> SEWER LINES 0_=150 ft. DISPOSAL FLD. PROP. LIME <br /> DISTANCE TO NEAREST: SEPTIC TAN% _ c OTHER WELL PlTS1SUMP$ _ <br /> FOVNOATi0N AGRICULTUR. WELL <br /> USE TIPS OF WELL PR05LEh1 AREA CONSTRUCTION SPECIFICATIONS <br /> 1 <br /> INTENDED US- �...__, Ois. o!Well Excavation Dia. of Well Casing <br /> C• Induarrial ❑ Dpen Boucm ❑ Manteca Type of Casing,. . Specifications— <br /> ;.1 Domsstic/Private n Gravel pack L7;Tracy Type of Grout��_ <br /> I'} Public - <br /> 1 Clthar $ pp ha Deprh dI Grout Seel <br /> Oil BOY�1']yS Surface Sea! tnsrall.d by - •-•'- <br /> Ippma. Dept•. 1 i estem O <br /> i i trrigarion H.P. Sleto Work Done <br /> Repair Wore Done J Typt o: Pump Seallnli lsateri`l 6 Depth d <br /> Wall Oestruction 0 weliI Dianetor }YL'er ?taurial a Depth <br /> Depjn <br /> waitable within 100 feet.) <br /> I <br /> 7YPE OF SEPTIC WORY.: NEW INSTALLATION I I R£PAIR;AODITION I 1 DESTRUCTION I I {No sspuc system pr:miued if puGrc ss+.e: s <br /> > Residence commercial_ Other <br /> Installation wt; :+'••a: I ' <br /> Number of badreoms were( table depth <br /> Number or livrg a%its: �r - i <br /> ( Chauctef of W{'to a depth pf 3 feat: ' <br /> CepacitY No. Comparlmerts j <br /> SEPTIC TANK D Typo/)Afg Method of Disposal <br /> PKG.7`4 ^' PLT.Ll I - Pro^ nv Line <br /> istance to nearest: 4V°II Fo jd°Dior. .� , <br /> _ Total length/sue_ - <br /> i <br /> Li.CH:NG LINE G o. b Length of Linea '—" Property Line <br /> Ll pistance to n6erast: Wall Foundation <br /> F1LT c?. .,ED ( . <br /> Siss Number <br /> SEEPAGE PITS t I Depth —'- Propern/ Line <br /> LI Distance to nearest: Well SUMPS Foundation <br /> + , <br /> DISPOSAL PONDS O <br /> I `+a:aby unify that t neve prepared his application and hat the work will b"done in accordance with San,foatauin county Drd;nenees. state a++�. z*< <br /> tars and regu'al ons of the Sin Joaauln County <br /> Hort+e owner i Hennaed rot Sinntl,i signature County <br /> the!ollowing: "I Cnrify that in the performance of the work for which This permit ie issue(!. 1 shat ac <br /> Ati <br /> lion <br /> s of <br /> employ any pati fro the person in pinch Irli that intheper(ormanuco!the work lot which this permit z 10 workman's coMptn5b ,s isoued,fI s`all employ Pe��rs+subjecting rt t0 workmen's Eompenir. <br /> lion laws of California!' <br /> The appl'�eent�{ust w6 fol all lrequired ''`nsPollions. Complete drawing on a�u I: See, tEiC$E3 F1CJllYe <br /> /.! Title: Dats: ..�ll '�— <br /> Signed X � <br /> FO DEPAhTMENT USE ONLY <br /> A <br /> I Date <br /> Application Accepted by I Data 1'-121. -?•/ <br /> al Inspection b <br /> PN or Grout irspec;ton by' ° _V Z r.!2;/-�5V <br /> Addi;lonei Commanu: I <br /> vifee <br /> Lt. Jokwuln county Py) c APpl ipant - Return i <br /> 1t Copi^s to: ravironments.1 Nealtbu Permit/ServiceaD <br /> 445 N San Jonnula, P 0 Box 2000. Stke, CA 95301 <br /> --�^^-•— 1 1 s RECEIVED BY DATE h <br /> FEE AMO!:l:T OUE AMOUNT FEI.iyIT�TFD ASH <br /> rrFo <br /> aX 1744 inEV. <br />